Evaluation of a School-Based Fruit and Vegetable Intervention Using a Digital Photography Method

Abstract

Objective: The primary objective is to use digital photography of food to assess if a policy, systems, and environment (PSE) intervention increases the amount and variety of healthful fruits and vegetables consumed at lunch by low-income 5th graders. Design: Quasi-experimental design. Participants/Setting: The sample consisted of low-income 5th grade students in the Providence School District, n = 130 (treatment school, n=75, control school, n=55). Intervention: Both the treatment and control students were assessed at baseline and post intervention to determine amount consumed and variety of fruit and vegetable using a digital photography of food method. Within the treatment school, four out of the six classrooms agreed to participate in the 8-lesson Student’s Take Charge in-class intervention. Main Outcome Measures: Consumption of healthful fruits and vegetables (excluded French fries, tomato sauce, and fruit juice) in cups and variety from digital photographs. Analyses: Consumption differences were assessed using the Mann-Whitney U for between group changes and Wilcoxon signed-rank test for within groups. Pearson chi-square compared variety. Results: There was a difference between groups for change in consumption of fruit (p.05). Within treatment group variety of fruits decreased (Baseline: 59.3% with 1 or 2 fruits; Follow-up: 30.9%), and within the control group, variety of fruits increased (Baseline:11.7% with 1 or 2; Follow-up: 33.3%). Variety of vegetables decreased in the treatment group (Baseline: 49.4% with 1 or 2; Follow-up: 8.6%), and variety of vegetables was minimal at both time points within the control group (Baseline: 6.7%; Follow-up:8.3%). Although at baseline treatment children were more likely to have at least one fruit (59%) or vegetable (49%) than children in the control school (fruit 12%, vegetables 7%; p.05). Conclusions and Implications: The intervention was not successful in increasing consumption or variety of fruits and vegetables. The observed decrease in fruit consumption in the experimental group may be associated with different fruit options on observation days. Future research should explore changes in the eating environment to increase availability of preferred healthful fruit and vegetable options.