Fruit and Vegetable Intake and Preferences Associated with the Northern Fruit and Vegetable Program (2014–2016)

Three-Year School-Based Multicomponent Intervention May Change Fruit and Vegetable Preferences in Primary School Children-A Quasi-Randomized Trial

Preference could be the trigger for fruit and vegetable (FV) consumption in children and could be modified by appropriate intervention to increase the acceptance of FVs. The primary objective of this study was to investigate the effects of the three-year school-based multicomponent intervention "Nutri-školica" on the FV preferences of primary school children. It also aimed to explore whether a positive change in FV preferences could lead to an increase in actual FV consumption. The study was conducted in 14 primary schools from the city of Zagreb on 193 children (52.3% boys; age, 7.7 ± 0.4 years; n = 85 in the control group and n = 108 in the intervention group) who completed a preference questionnaire before and after the intervention with a 5-point hedonic smiley-face scale, where 5 means "I like it a lot." The per-protocol approach was used for data analysis (28.3% of children from the study sample). After the intervention, children in the intervention group (before: 3.1 ± 0.8; after: 3.5 ± 0.8) increased their FV preferences significantly more than children in the control group (before: 3.2 ± 0.8; after: 3.3 ± 0.7). Children's FV preferences changed most toward the varieties for which they had the least preferences at the beginning of the study. Participation in the intervention had a stronger effect on changing FV intake than change in FV preferences among primary school children. In summary, the present study highlighted that a targeted intervention can increase children's FV preferences, but that participation in the intervention is substantial for increasing FV intake.

Intake of Fruits, Vegetables, and Sugar-Sweetened Beverages among a Sample of Children in Rural Northern Ontario, Canada

There is evidence to suggest that dietary intake of children differs by rural/urban place of residence: rural children may have a higher intake of foods high in fat and sugar than those living in urban environments. The aim of this study was to examine the intake of fruits and vegetables (FV) and the frequency of sugar-sweetened beverage (SSB) consumption, among a sample of rural children in Northern Ontario, Canada, in two different seasons. Sociodemographic factors and children’s FV and SSB intake were measured using two repeated cross-sectional surveys, and seasonal information was based on the month of data collection. Logistic regressions were used to examine the odds of children eating five or more FVs, and the odds of ‘frequently or always’ consuming SSBs. During the fall, children reported eating five or more FV more often, when compared to winter (53.9% vs. 48.3%). In the fall, 25.8% of children reported ‘frequently or always’ drinking SSB, compared with 16.9% in winter. Indigenous children were less likely to eat five or more FV (OR 0.34 (95% CI 0.12–0.95)) in the fall when compared to non-Indigenous children. Findings indicate that intake of FV among rural students in this region is low, and the frequency of SSB is high, when compared with national recommendations.

Using predicted marginal effects to assess the impact of rurality and free and reduced lunch eligibility on a school-based nutrition intervention

PURPOSE

To estimate the impact of a school-based nutrition education intervention in rural schools and schools with high free and reduced lunch (FRL) eligibility rates.

METHODS

As part of the evaluation of the Healthy Schools Healthy Students intervention, 20 schools were randomized to control and intervention conditions. Pre (October 2017) and posttest (April 2018) data were analyzed using multi-level linear regression models to estimate the intervention effect for multiple outcomes controlling for school-level demographic characteristics. We report the predicted marginal effect overall and specifically for rural; high FRL; and rural, high-FRL schools.

RESULTS

We observed at least one significant intervention effect for food group knowledge, liking to eat fruit, beliefs about how healthy fruits are, non-taste test fruit preferences, liking to eat vegetables, beliefs about how healthy vegetables are, and taste test vegetable preferences. We observed differential intervention effects for all outcomes except taste test vegetable preferences based on rural and high-FRL status.

CONCLUSIONS

Interventions do not necessarily have the same impact on all participants. Sub-analyses can reveal these important differential effects, as they have important implications for policymakers, program implementers, and evaluators. Resources and interventions should be allocated where they will have the greatest impact.

A randomized control trial of a Canadian-based school food program on the home food environment

Research provides evidence of take-home effects in school-based nutrition interventions, citing children as important influencers of family nutrition, acting as agents of change in the household and potentially influencing family food consumption. Therefore, the purpose of this randomized control trial was to examine whether implementation of a centrally procured school food program would produce changes in children's home food environment, including fruit and/or vegetable availability and parental modelling of fruit and/or vegetable consumption. A secondary objective was to investigate whether children's fruit and/or vegetable intake predicted their parent's fruit and/or vegetable intake. A total of 60 schools participated in the evaluation, including 2443 students (and their parents) in grades 5-8. Findings indicated that the intervention did not produce take-home effects on children's home availability of fruit (p = 0.52) and vegetables (p = 0.67) or parental modelling of fruit (p = 0.26) and vegetable consumption (p = 0.78), which may be related to the fact that only food provisions were given. However, children's fruit and vegetable consumption predicted parents' fruit and vegetable consumption (p < 0.001), thereby indicating that children may possess the capacity to influence home nutrition. Future school-based nutrition interventions are recommended to be multi-component (e.g. experiential learning, parent involvement) and that encourage nutrition leadership opportunities for children in the home context.

Examining Elementary School Children's Knowledge about Food and Nutrition in Southwestern Ontario, Canada

Purpose: Knowledge is fundamental to helping children make nutritional choices that support lifelong healthy behaviours. This study (i) investigates elementary school children's knowledge about food and nutrition and (ii) identifies sociodemographic factors influencing children's reported knowledge.Methods: In 2017-2019, a survey was administered to 2443 students (grades 5-8) at 60 schools across southwestern Ontario, Canada, and a parent survey was used to validate self-reported sociodemographics. Multiple regression was used to analyse children's knowledge scores and related sociodemographic factors. A total knowledge score was calculated by summing correct responses derived from 46 individual questions in the student survey.Results: Mean total knowledge score was 29.2 out of a possible 46 points (63.5% correct). Students demonstrated some knowledge and awareness of strategies to encourage fruit and vegetable consumption, healthy food selection, nutrition, and food preparation skills, although knowledge of food guide recommendations and locally sourced produce were limited. Female sex, family income, and rurality were associated with higher knowledge scores.Conclusions: Results provide insight regarding strengths and gaps in elementary-school children's food and nutrition knowledge. Poor performance of students on specific food guide-related questions suggests that the general guidance of the 2019 Canada's Food Guide might be better understood by children and adolescents.

Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

OBJECTIVE

Fruits and vegetables (FV) distribution interventions have been implemented as a public health strategy to increase children's intake of FV at school settings. The purpose of this review was to examine whether snack-based FV distribution interventions can improve school-aged children's consumption of FV.

DESIGN

Systematic review and meta-analysis of articles published in English, in a peer-reviewed journals, were identified by searching six databases up to August 2020. Standardised mean differences (SMD) and 95 % CI were calculated using a random effects model. Heterogeneity was quantified using I2 statistics.

SETTING

Population-based studies of interventions where the main focus was the effectiveness of distributed FV as snacks to schoolchildren in North America, Europe and Pacific were included.

RESULTS

Forty-seven studies, reporting on fifteen different interventions, were identified; ten studies were included in the meta-analysis. All interventions were effective in increasing children's consumption of FV, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children's consumption of FV, particularly for multi-component interventions at post-intervention (SMD 0·20, 95 % CI 0·13, 0·27) and free distribution interventions at follow-up (SMD 0·19, 95 % CI 0·12, 0·27).

CONCLUSIONS

Findings suggest that FV distribution interventions provide a promising avenue by which children's consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration and follow-up evaluation are needed to improve comparability across studies.

Children's perceptions of a Centrally Procured School Food Program in southwestern Ontario, Canada

INTRODUCTION

This qualitative study investigates children's perceptions of the influences of a Centrally Procured School Food Program on their dietary behaviours and their recommendations on how to improve the program.

METHODS

The observations of 208 students aged 9 to 14 years (Grades 5-8) at 21 elementary schools were collected through focus groups in 2017/18. The larger intervention consisted of a 10-week program offering daily snacks (i.e. fruit, vegetables, whole grains, dairy, meat alternatives) for elementary school children in southwestern Ontario, Canada.

RESULTS

The participants' overall impressions of the program were positive. They noted reduced hunger, increased energy and improved nutrition. Many children felt that the program changed their dietary patterns at home as well as at school, particularly in terms of eating more fruit and vegetables. The snack program also enabled children to try healthy foods.

CONCLUSION

Most participants considered the program to be beneficial in promoting healthy eating. Participants recommended adding educational activities, expanding the variety of foods and increasing child involvement in selecting and preparing foods.

Fruit and Vegetable Lesson Plan Pilot Intervention for Grade 5 Students from Southwestern Ontario

The purpose was to create and assess the impact of food literacy curriculum alongside a centrally procured school snack program among grade five students in Southwestern Ontario, Canada. Grade five students (N = 287) from five intervention and three controls schools participated in an 8-week food delivery program. In addition to the food delivery program, intervention schools received a resource kit and access to 42 multidisciplinary food literacy lesson plans using the produce delivered as part of the food delivery program. Participants completed matched pre- and post-test online surveys to assess fruit and vegetable intake, knowledge, preferences, and attitudes. Descriptive analyses and changes in scores between the intervention and control schools were assessed using one-way ANOVAs, paired samples t-tests, and McNemar’s tests. In total, there were 220 participants that completed both the pre- and post-test surveys. There was a significant improvement in fruit and vegetable intake (p = 0.038), yet no differences in knowledge of the recommended number of food group servings, knowledge of food groups, or fruit and vegetable preferences or attitudes were observed. Integrating nutrition lesson plans within core curricula classes (e.g., math, science, and literacy) can lead to modest increases in fruit and vegetable intake.