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Evaluation of a Fruit and Vegetable Distribution Program --- Mississippi, 2004--05 School Year

Although diets high in fruit and vegetables are associated with decreased risk for many chronic diseases (1), consumption of fruit and vegetables among children is below recommended levels (2). During the 2004--05 school year, the Mississippi Department of Education Child Nutrition Program initiated the Mississippi Fresh Fruit and Vegetable Pilot Program. The program was designed to 1) increase student access to fresh fruit and vegetables, 2) increase the degree of student preference for fruit and vegetables, and 3) increase fruit and vegetable consumption. The 25 schools selected to participate in the program distributed fresh fruit and vegetables free of charge during the school day and provided nutrition education activities to promote and support consumption of fruit and vegetables. An evaluation of the program was conducted using a pretest in the fall (before the program was implemented by the schools) and a posttest in the spring (at the end of the school year). This report summarizes the findings of that evaluation, which indicated that the program might have 1) increased the variety of fruit and vegetables ever tried by students from all three grades sampled (5th, 8th, and 10th); 2) increased the degree of preference for fruit among 8th-grade and 10th-grade students; 3) promoted positive attitudes toward eating fruit among 8th-grade students; 4) increased consumption of fruit, but not vegetables, among 8th-grade and 10th-grade students; and 5) decreased preference for fruit and vegetables, the belief that they could eat more vegetables, and willingness to try new fruit and vegetables among 5th-grade students. The results of this evaluation suggest that the distribution of fresh fruit at school free of charge to secondary school students might be an effective component of a comprehensive approach for improving student dietary behaviors; however, distribution of fresh vegetables might be more effective with changes in program implementation.

Evaluation of the pilot program featured a one-group (no comparison) pretest-posttest design involving students in grades 5, 8, and 10 from five of the 25 schools* participating in the pilot program. The five evaluation schools were selected on the basis of grade levels served, geographic area, urbanicity, and racial composition but were not intended to be representative of students in the pilot program or of students in the entire state.

The evaluation of the pilot program consisted of a survey and a 24-hour dietary recall interview. The survey assessed changes in the following during the school year: 1) the variety of fruit and vegetables ever eaten by students, 2) their attitudes toward fruit and vegetables, 3) their willingness to try fruit and vegetables, 4) their degree of preference for and familiarity with fruit and vegetables, and 5) their intentions to eat fruit and vegetables. The survey was administered by trained data collectors during the school day to 725 students in grades 5, 8, and 10 in the five selected schools. The 24-hour dietary recall interview was conducted to assess changes in student consumption of fruit and vegetables during the school year. Dietitians and trained nutrition interviewers interviewed a random sample of 207 students in grades 8 and 10 representing three of the five selected schools. They collected information about student dietary intake for the previous 24 hours by using an adaptation of the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention study's 24-Hour Dietary Recall Interview (3). All baseline data were collected in fall 2004, before the pilot program was initiated, and follow-up data were collected in spring 2005, at the end of the school year. Follow-up response rates were 91% for the student survey and 92% for the dietary recall interviews, yielding a final survey sample of 660 students and a final dietary recall interview sample of 191 students (Table 1). All parents provided consent, and all students agreed to participate.

Dietary recall responses were analyzed for fruit and vegetable servings based on the U.S. Department of Agriculture (USDA) Pyramid Servings Database (Version 2) (4). Recall data also were analyzed for selected vitamins, minerals, and macronutrients with the Food Intake Analysis System (FIAS), which uses the 1994--1996 and 1998 USDA Continuing Survey of Food Intakes by Individuals (CSFII) nutrient database (5,6). Changes in student survey data and dietary recall data between baseline and follow-up were compared using paired t tests.

The variety of fruit and vegetables ever eaten increased significantly among students in all three grades (Table 2). However, only 8th-grade students had significant increases in positive attitudes toward eating fruit and vegetables (p<0.01), in their beliefs that they could eat more fruit (p<0.01), and in their willingness to try new fruit (p<0.01). The willingness of 5th-grade students to try new fruit and new vegetables declined significantly (p=0.01 and p=0.03, respectively), as did their belief that they could eat more vegetables (p=0.04).

Changes in degree of student preference for fruit and vegetables also varied by grade. Degree of preference for fruit increased significantly among 8th-grade and 10th-grade students (p=0.01 and p<0.01, respectively) but decreased significantly among 5th-grade students (p=0.03). Degree of preference for vegetables decreased significantly among 5th-grade and 8th-grade students (p<0.01 and p=0.01, respectively) but remained unchanged among 10th-grade students. Intention to eat fruit increased significantly among 10th-grade students (p=0.01) but not among 5th-grade and 8th-grade students. Significant changes in intention to eat vegetables were not detected among students in any of the grades.

Student consumption of fruit in school and overall increased significantly by 0.34 and 0.61 servings per day, respectively (p<0.01) (Table 3) among the 8th-grade and 10th-grade students who participated in dietary recall interviews. Student consumption of vegetables in school decreased significantly (p=0.05), but consumption of vegetables overall did not change. Intake of vitamin C increased overall, and intake of dietary fiber increased in school. Consumption of other nutrients did not change significantly.

Reported by: DJ Schneider, MS, G May, Child Nutrition Program, Mississippi Dept of Education; T Carithers, PhD, Dept of Family and Consumer Sciences, Univ of Mississippi. K Coyle, PhD, S Potter, MS, ETR Associates, Scotts Valley, California. J Endahl, PhD, Office of Analysis, Nutrition, and Evaluation, Food and Nutrition Svcs, US Dept of Agriculture. L Robin, PhD, M McKenna, PhD, K Debrot, DrPH, Div of Adolescent and School Health, J Seymour, PhD, Div of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

The results of this evaluation suggest that the Mississippi Fresh Fruit and Vegetable Pilot Program might have helped to increase the variety of fruit and vegetables ever eaten by students in all three grades. The program also might have increased the positive attitudes of 8th-grade students toward eating fruit and vegetables, their willingness to try new types of fruit, and their degree of preference for fruit. Among 10th-grade students, the program might have increased their preferences for fruit and their intentions to eat fruit. Students in the 8th grade expressed significantly less preference for vegetables after the program than before. Students in grades 8 and 10 also increased their consumption of fruit but not vegetables during the school year. Other evaluations of programs to improve fruit and vegetable consumption have noted similar findings (7). This program appeared to be more successful with 8th-grade and 10th-grade students than with 5th-grade students, whose reported willingness to try new fruit and vegetables and degree of preference for fruit and vegetables decreased. The findings among 5th-grade students are consistent with results of research on food preferences across the lifespan, which indicates that younger children tend to prefer sweeter, more energy-dense foods (i.e., foods with high calorie content by weight, such as butter) rather than energy-dilute foods (i.e., foods with low calorie content by weight, such as vegetables or plain popcorn), but that these preferences begin to change at puberty (8). These results are also consistent with research that indicates that younger children dislike an increasing number of foods as they taste new foods (9).

The findings in this report are subject to at least three limitations. First, because of the one-group pretest-posttest design and limited sample size for the dietary recall interviews, the study results do not indicate whether the findings are attributable to the program alone or might have been influenced by seasonality and other unknown trends. Second, the intervention itself was modest in intensity because the only required element was the distribution of fresh fruit and vegetables free of charge to students. Although schools did augment the distribution with various nutrition education activities, the intensity of these activities varied from school to school. Finally, this was a new program for Mississippi schools, many of which experienced start-up and implementation challenges that might have affected the overall impact of the program.

The results of this evaluation suggest that the distribution of fresh fruit at school free of charge to secondary school students might be an effective component of a comprehensive approach for improving student dietary behaviors; however, distribution of fresh vegetables might be more effective with changes in program implementation. Further research is needed to determine the effectiveness of this type of program among youths.

References

  1. US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans, 2005. 6th edition. Washington, DC: US Government Printing Office; January 2005.
  2. Krebs-Smith SM, Cook A, Subar A, Cleveland L, Friday J, Kahle LL. Fruit and vegetable consumption intakes of children and adolescents in the United States. Arch Pediatr Adolesc Med 1996;150:81--6.
  3. Lytle LA, Nichaman MZ, Obarzanek E, et al. Validataion of 24-hour recalls assisted by food records in third-grade children. The CATCH Collaborative Group. J Am Diet Assoc 1993;93:1431--6.
  4. Cook AJ, Friday JE. Pyramid servings database for USDA survey food codes. Version 2.0. Beltsville, MD: US Department of Agriculture, Agricultural Research Service, Community Nutrition Research Group; 2004. Available at http://usna.usda.gov/cnrg/services/foodlink.html#database.
  5. University of Texas-Houston. Food Intake Analysis System, Millennium Edition. Houston, TX: University of Texas-Houston School of Public Health; 2005. Available at http://www.sph.uth.tmc.edu/dellcahl/default.asp?id=2146.
  6. National Technical Information Service, US Department of Commerce, US Department of Agriculture, Agricultural Research Service. Continuing Survey of Food Intakes by Individuals (CSFII) in 1994--96 and 1998 and the Diet and Health Knowledge Survey (DHKS) in 1994--96. Springfield, VA: US Department of Commerce; 1998. CD-ROM accession no. PB2000-500027.
  7. Perry CL, Bishop DB, Taylor G, et al. Changing fruit and vegetable consumption among children: the 5-a-day power plus program in St. Paul, Minnesota. Am J Public Health 1998;88:603--9.
  8. Drewnowski A. Sensory control of energy density at different life stages. Proc Nutr Soc 2000;59:239--44.
  9. Skinner JD, Carruth BR, Wendy B, Ziegler PJ. Children's food preferences: a longitudinal analysis. J Am Diet Assoc 2002;102:1638--47.

* The 25 schools were selected competitively by the Mississippi Department of Education from among those that applied for funds for the Fresh Fruit and Vegetable Pilot Program.

Because young children might not be able to provide reliable data on dietary recall interviews, only 8th-grade and 10th-grade students were administered these interviews.

Table 1

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Table 2

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Table 3

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Date last reviewed: 9/7/2006

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