Fresh Fruit And Vegetable Program Research Articles

Impact of Child Nutrition Programs Offered in Schools on Daily Nutrition and Dietary Quality

ObjectivesThe average Healthy Eating Index-2015 (HEI) score for children 2–17 years of age is 53.9 out of 100. HEI scores for dietary quality directly and positively impact children’s health, academic performance, and their futures. Because school Child Nutrition Programs (CNPs) impact a large proportion of US children, it is important to evaluate these programs to determine the nutrition they are providing to children, as well as their impact on dietary quality. Thus, the purpose of this study is to determine the overall nutrition provided by the four CNPs that can be implemented consistently and collectively each school day [School Breakfast Program (SBP), National School Lunch Program (NSLP), Fresh Fruit and Vegetable Program (FFVP), and the Afterschool Snack Program (ASSP)] and to determine the dietary quality score achieved collectively by serving each of these four CNPs. MethodsThis cross-sectional content analysis included four-week sample cycle menus for each of CNPs offered to elementary-aged children. Sample menus for breakfast (SBP) and lunch (NSLP) were actual cycle menus from the Cooking for Kids program. Sample menus for FFVP and ASSP were created by two researchers, who are CNP experts. Nutrient content was determined using nutrient analysis software. Dietary quality scores were determined using the HEI-2015. ResultsThe proportion of daily nutrient needs met by the combined menus ranged from 0.15% to 403.7%, with an average proportion of 124.0%. The menus exceeded child daily nutrient needs for 18 of the 30 nutrients and met at least 50% of needs for 8 nutrients. The combined menus had an average 29.4-point (54.5%) higher HEI score compared to the average HEI score of the 2–17 year-old US child’s diet (p = 0.002). Significant differences in HEI scores between the combined menus and the diet of the average US child included whole grains, dairy, added sugar, and total score favoring higher dietary quality in the combined menus (p < 0.05). ConclusionsThe results of the current study support why school districts should implement all four CNPs (SBP, NSLP, FFVP, ASSP) within their schools if possible, especially in low-income areas where children may not be provided with adequate nutrition outside of school, to provide children with the highest dietary quality meal patterns and to greatly contribute to children’s daily nutrient needs. Funding SourcesNone.

O26 Local Farmers and Food Procurement in Mississippi Delta Schools: Fertile Ground

<h3>Background</h3> School food service administrators in the Mississippi Delta are procuring fruits and vegetables (FV) grown mainly outside of the agricultural region. Opportunities for local farmers to increase profits and provide fresh FV to children attending Mississippi Delta schools may be prolific. <h3>Objective</h3> Objectives of this study were to determine and compare FV procurement amounts (weight and cost) in 2 Mississippi Delta school districts, 1 participating in the Fresh Fruit and Vegetable Program (FFVP) for 2 consecutive years. <h3>Study Design, Setting, Participants</h3> Procurement data from 2 Mississippi Delta school districts, academic years 2018-2019 and 2019-2020, were obtained and compiled. Only foods categorized as FV were included. <h3>Measurable Outcome/Analysis</h3> Amounts of procured FV were calculated as weight in pounds and cost in dollars for each school district and for each academic year. <h3>Results</h3> In the FFVP district, 18 and 16 different fruits were purchased in respective years with apples, oranges, mixed fruit, and either pears or juice representing half of expenditures and by weight. For vegetables 20 and 19 different types were purchased in respective years with potatoes, greens and either corn or tomatoes representing half of expenditures and potatoes, tomatoes, and either greens or legumes representing half by weight. In the non-FFVP district, 12 different fruits were purchased in both years with apples and juice representing half of expenditures and juice alone accounting for 50% by weight. For vegetables 18 and 17 different types were purchased in respective years with potatoes, tomatoes and either corn or juice representing half of expenditures and by weight. Changes in percentage amounts were small except for fruits (increase) for the FFVP school district. <h3>Conclusion</h3> These school districts spend substantial amounts on non-locally sourced produce, much of which could be grown in the deep fertile soil of the Mississippi Delta.

Opportunities for Partnership in Local Food Procurement: Mississippi Delta Schools

Abstract Objectives Procuring food for school meals is costly in a region like the fertile MS Delta. Hence, efforts to procure foods locally may yield substantial benefits in terms of economic return to the area and positive impacts on children's diets. The objective of this study was to determine food procurement amounts in two Mississippi Delta school districts, one participating in the Fresh Fruit and Vegetable Program (FFVP) and illustrate potential economic impacts of purchasing local. Methods Procurement data from two Mississippi Delta school districts, academic years 2018–2019 and 2019–2020, were compiled and grouped into 8 food categories. The food categories were fruits, vegetables, grains, protein, dairy, added sugars, fats, and miscellaneous. Amounts of procured foods were converted to weight in pounds and cost in dollars. Results For the FFVP district, dairy accounted for the largest cost (34%) followed by protein (23%), grains (19%), fruits (13%), and vegetables (10%) in 2018–2019. In 2019–2020, grains accounted for the largest cost (26%) followed by fruit (20%), protein (19%), and vegetables (12%). For the non-FFVP district, protein accounted for the largest cost (25%) followed by grains (24%), dairy (18%), fruits (14%), and vegetables (14%) in 2018–2019. In 2019–2020, grains accounted for the largest cost (26%) followed by protein (24%), dairy (19%), fruits (16%), and vegetables (11%). Conclusions Although school districts purchase substantial amounts of dairy, grains, protein, fruits and vegetables, very little if any is procured locally. Encouraging school food service administrators to connect with and purchase foods from local farmers may provide an economic boost to the agricultural community and will facilitate serving fresh, nutrient rich foods, such as fruits and vegetables, to school children. Funding Sources This research was funded by the USDA Agricultural Research Service.

Evaluation of Preferences Among Students Participating in the US Department of Agriculture Fresh Fruit and Vegetable Program

Improving children's fruit and vegetable (FV) preferences may be important as preferences can predict FV consumption. The purpose of this study was to evaluate FV preferences over time, with repeated experience, as part of the Fresh Fruit and Vegetable Program (FFVP). Fruits (F; N=28) and vegetables (V; N=29) were distributed twice a week, over 35 weeks, at a participating FFVP school (N=236 students, 12 teachers, K-2nd grade). Preference ratings using 3-point Likert scale were analyzed over 35 weeks. For 57 FVs rated for preference, ratings revealed that F had higher frequency of children choosing "I like it" than for V (78% F; 38.2% V; p < .05) and liking distribution was different between F and V (p < .001). Significant relations were found between liking and: (1) grade (r=-0.02, p=.02), and (2) time (r=-0.09, p < .001). Models indicated that V served (β=-0.40), timepoint (β=-0.07), and grade level (β=-0.02) accounted for significant variance for preference ratings (R2 =0.17, p < .001), indicating that preference ratings declined over time. Fruits were preferred over vegetables. Overall preference ratings were negatively impacted by time, grade level, and vegetables served. Being exposed one time to a variety of FVs did not improve ratings for vegetables.

Agent-based modeling insights into the optimal distribution of the Fresh Fruit and Vegetable Program

The Fresh Fruit and Vegetable Program (FFVP) program provides a free fresh fruit or vegetable snack to children in low-income schools between two and five times a week. This is an important nationwide program, but current funding levels are insufficient to reach all eligible schools. Thus, there is a need to develop insight on contextual factors that may impact the effectiveness of FFVP in facilitating the development of childhood food preferences. An agent-based model of preference formation is used to understand how exposure to FFVP in early elementary school may affect preferences for healthy food by 6th grade. Preferences are modeled using the temporal difference learning algorithm used by Hammond et al. (2012). This model simulates habit formation in the context of food by modeling preference formation in terms of positive or negative feedback about the food most recently consumed. The model is designed to provide insights into how different patterns of exposure to FFVP affect preferences, and how living in a food desert changes the effect of FFVP. We use data on 35,981 students from Arkansas elementary schools (from 2008 to 2016) and information about the commercial food environment in Arkansas communities to populate the model. We find that early FFVP exposure is more beneficial than late exposure conditional on the number of years exposed. We also find that FFVP is more beneficial for children who grow up in environments lacking healthy food.

Qualitative Research in Phoenix, AZ, Exploring Support for Public–Private Partnerships to Expand the Reach of the Fresh Fruit and Vegetable Program

BackgroundFruit and vegetable (F/V) consumption among school-aged children falls short of current recommendations. The development of public–private partnerships (PPPs) has been suggested as an effective approach to address a number of public health concerns, including inadequate F/V consumption. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks at least twice per week in low-income elementary schools. In addition to increasing F/V consumption behaviors at school, children participating in the FFVP make more requests for F/V in grocery stores and at home, suggesting the impact of the program extends beyond school settings. ObjectiveThis study explored the potential for establishing successful PPPs between schools and food retailers to promote the sales of F/V in low-income communities. DesignSemi-structured interviews and focus groups were conducted with participants from 4 groups of stakeholders. Participants/settingGrocery store and produce managers from 10 grocery stores, FFVP personnel from 5 school districts and 12 schools, and parents of children attending 3 different FFVP-participating schools, all in the Phoenix, AZ, metropolitan area participated in interviews and focus groups. Statistical analyses performedData were analyzed using a directed content analysis approach to examine benefits, barriers, and strategies for developing a PPP. ResultsKey perceived benefits of creating a PPP included the potential to increase store sales, to enhance public relations with the community, and to extend the impact of the FFVP to settings outside of schools. Barriers included offering expensive produce through the FFVP and the potential lack of communication among partners. Strategies for developing a PPP included using seasonal produce and having clear instructions for teachers and staff. Parents reported their children requesting more F/V as a result of FFVP participation. ConclusionsStakeholders support forming PPPs. Partnerships between FFVP schools and retailers can be mutually beneficial and have a positive impact on children and their families.

Fresh Fruit and Vegetable Program and Requests for Fruits and Vegetables Outside School Settings

BackgroundConsumption of fruits and vegetables (F/V) among elementary school-aged children remains inadequate, especially among low-income children. The US Department of Agriculture’s Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks to children during the school day, outside of school meals. School-based initiatives are successful in changing behaviors in school settings; however, their influence on behaviors outside of schools needs investigation. ObjectiveTo examine whether FFVP participation is associated with F/V requests at stores, self-efficacy to ask for and choose F/V at home, and F/V consumption. DesignCross-sectional study. Participant/settingFourth graders in six classrooms (n=296) from three urban, low-income school districts in Phoenix, AZ, were surveyed during 2015; one FFVP and one non-FFVP school from each district that were similar in school size, percent free/reduced-price meal eligibility, and race/ethnicity of enrolled students were selected. Main outcome measuresChildren’s self-reported F/V requests during shopping, their self-efficacy to ask for and choose F/V at home, and F/V consumption on the previous day (non-FFVP school day) were measured using questions adapted from validated surveys. Statistical analysisMultivariable mixed-effect regression models, adjusting for clustering of students within classes and classes within schools were explored. ResultsIn models adjusting for individual-level factors (ie, age and sex) only, several significant positive associations were observed between school FFVP participation and healthier F/V outcomes. After additionally adjusting for school-level factors (ie, total enrollment and % Hispanic/Latino students) significant associations were observed between school FFVP participation and more requests for vegetables during shopping (P<0.001), higher scores on self-efficacy to choose vegetables at home (P=0.004), stronger preferences for vegetables (P<0.001), and more frequent consumption of fruit (P=0.006). ConclusionsSchool FFVP participation was associated with more requests for vegetables during shopping and higher self-efficacy to make healthy choices at home, suggesting the influence of the FFVP may extend beyond the school day.

Fruit and Vegetable Preferences and Identification by Kindergarteners through 2nd-Graders With or Without the US Department of Agriculture Fresh Fruit and Vegetable Program

ObjectiveThe US Department of Agriculture Fresh Fruit and Vegetable Program (FFVP) allows schools to increase fruit and vegetable (FV) exposure by distributing FV as snacks. The objective of this study was to compare kindergarten through second (K-2nd)-graders who were exposed or not to FFVP for preferences and identification. Design, Setting, ParticipantsThe FV Preference Survey for K-2nd-graders contained 12 fruits and 12 vegetables, a 3-Likert scale (liked it, okay, don't like it), and an I don't know option. Data were collected from K-2nd-graders at 2 elementary schools near Chicago, IL (n = 435, FFVP school, n = 235 with 12 teachers; non-FFVP school, n = 200 with 10 teachers). Main Outcome Measure(s)Mean preference scores. AnalysisChi-square, Mann-Whitney U, and multiple linear regression analyses compared school data (P < .05). ResultsThere were significant differences in mean preference scores, with higher fruit scores at the FFVP school (1.8 ± 0.6) than at the non-FFVP school (1.7 ± 0.6). In contrast, there was a higher vegetable score for the non-FFVP school (1.3 ± 0.9) than for the FFVP school (1.2 ± 0.9). The school variable had weak impact on fruit ranking (multivariate coefficient = 0.01; P < .05). For fruits and vegetables and combined, there were fewer I don't know responses in the FFVP (χ2 = 149.080; P < .01). Conclusions and ImplicationsAt the FFVP school, fewer I don't know responses suggested better FV identification. Non-FFVP students had higher vegetable preferences than did FFVP students. Tasting a variety of FV may help with identifying FV, but more research is needed to determine the impact on preferences.

Longitudinal Evaluation of Fruit and Vegetable Preferences Among K-2nd Grade Students Participating in the Fresh Fruit and Vegetable Program (FFVP)

To evaluate fruit and vegetable preferences over time, with repeated experience, as part of the Fresh Fruit and Vegetable Program (FFVP). Fruits (F=28) and vegetables (V=29) were distributed twice a week, over 35 weeks, at a participating FFVP-school (n= 236 students, 12 teachers, K-2nd grade). A 3-point Likert emoticon scale was used to evaluate student FV preferences. Preference ratings were analyzed, over 35 weeks, by descriptive statistics, Spearman's rho correlations, Mann-Whitney U, and linear regression with predictor variables including grade level, fruit or vegetable served, and time (week). For the 57 different FV rated for preference, ratings (n=10,335, F= 5,121; V=5,214) revealed that F had higher frequency of children choosing “I like it” than for V (78% F; 38.2% V). Preferences for F were higher ranked than for V (p<0.01) and liking distribution (liked, okay, didn't like) was different between F and V (p<.001). Significant relations were found between liking and: grade (r=-0.02, P=0.02), and time (r=-0.09, p<0.001). Models indicated that V served (compared to fruits; β=-.40), time point (β= -.07), and grade level (β=-.02) accounted for significant variance for preference ratings (R2=0.17, p<.001), indicating that preference ratings went down over time. When modeled independently, this remained true for V (R2=0.007, p<0.001), but only time remained significant in the F preference model (R2=0.008, p<0.001). Fruits were preferred over vegetables. Overall preference ratings were negatively impacted by time, grade level, and vegetables served. Being exposed to a variety of FV, generally, did not improve ratings for vegetables.

WISEly Improving Preschoolers Fruit and Vegetable Consumption at Home

This study examines the change in nutritional practices in homes of children participating in Together, We Inspire Smart Eating (WISE), an evidence-based curriculum to provide weekly food experiences. Besides Head Start programs, the curriculum has been adapted for children served by the Fresh Fruit and Vegetable Program (FFVP) in Kindergarten and first grade. This study represents data from families served by 13 centers in a Head Start program in a rural southern state. In eight centers, educators were not trained in WISE. In five centers, teachers were trained on the use of WISE. The WISE curriculum includes three key components: classroom curriculum, educator training, and parent education. All program components are based on published best practice recommendations from evidence-based sources on healthy nutrition. Parents were interviewed at enrollment and at the end of the school year by educators using modified Family Map Inventories (FMI), an interview developed to assess important aspects of the family and home environment associated with well-being in young children. Four ANOVA modeled the difference in consumption of WISE and comparison children controlling for consumption pre-enrollment, age of child, race/ethnicity of child, and parent education level. Group membership (WISE vs. Comparison) was a significant predictor of each model. The WISE curriculum resulted in improved reports of dietary intake in the home of preschool children. The curriculum was designed with a strong parent component which provided multiple opportunities for classroom activities to filter to the parent. While increases are small, they are consistent across measures suggesting a shift in nutrition practices in the home.

Impacts on student fruit and vegetable consumption and snack participation in the Canned, Frozen, and Dried pilot project of the Fresh Fruit and Vegetable Program (FFVP)

This congressionally mandated study of the Canned, Frozen, and Dried pilot project for the Fresh Fruit and Vegetable Program (FFVP‐CFD) assessed the impact of the pilot on students' fruit and vegetable consumption and wastage, FFVP participation, and schools' implementation strategies. The pilot allowed, but did not require, elementary schools that reported problems with access to fresh fruits and vegetables (FVs) to offer CFD snacks in the FFVP in school year (SY) 2014–2015. The evaluation used a pre/post design, comparing data from the fall of 2014, when the standard FFVP was in place, to data from the spring of 2015, when the FFVP‐CFD pilot was in place. For an evaluation of the pilot, we collected student dietary recalls to measure detailed food and nutrient intake in‐school, a student survey to assess student attitudes on FFVP snacks and FV preferences, and we observed one week of FFVP snack offerings in 101 classrooms in 34 pilot schools in four pilot states (Alaska, Delaware, Kansas, and Maine) in both fall and spring of SY 2014–2015. Although FFVP‐CFD study findings are not generalizable to other schools in the FFVP nationwide, they do provide important information on students' attitudes and preferences for specific fruits and vegetables in selected small and rural schools in four pilot states, including Alaska, which is often excluded from national school nutrition evaluations. The final evaluation report is in clearance at USDA. It is anticipated that the report will be cleared by April 2017 and that we will present the impact findings for the first time publicly at EB 2017.Support or Funding InformationEvaluation funded by the Food and Nutrition Service, USDA.

USDA Fresh Fruit and Vegetable Program Is More Effective in Town and Rural Schools Than Those in More Populated Communities.

We attempted to determine effects of the United States Department of Agriculture (USDA) Fresh Fruit and Vegetable Program (FFVP) on variety and frequency of fruit and vegetable intake by students in schools from different locales. Data were derived from the 2011-2012 Indiana FFVP Student Survey completed by 4229 fourth-sixth graders. Effects were studied within 2 groups, 39 city and suburb schools, and 12 town and rural schools. Differences in students' responses over time to 2 items measuring variety and 10 items measuring fruit and vegetable intake frequency were determined with multilevel regression models. Town and rural students were 1.2 times more likely to eat different kinds of fruit (p = .04) and vegetables (p = .01) daily, and increased fruit (+1.0 time/day; p < .01) and vegetable intake frequency (+0.5 times/day; p = .03). City and suburb students increased fruit intake frequency (∼0.8 times/day; p < .01) but not vegetable intake frequency or daily variety (p > .05). FFVP improved fruit and vegetable eating behaviors in the "town and rural" group, but was only partially effective in the "city and suburb" group. Strategies to implement FFVP may need to differ depending on school locale.

Student feedback to improve the United States Department of Agriculture Fresh Fruit and Vegetable Program

BACKGROUND/OBJECTIVESFruit and vegetable consumption of children in the United States falls below recommendations. The U.S. Department of Agriculture Fresh Fruit and Vegetable Program (FFVP) is a national free-fruit and vegetable school distribution program designed to address this problem. This permanent, legislated program provides funding to qualified elementary schools for provision of additional fruit and vegetables outside of school meals. The objective of this study was to understand children's perceptions of FFVP after the intervention and formulate recommendations that may improve success of the intervention.SUBJECTS/METHODSSecondary data were obtained from 5,265 4th-6th graders at 51 randomly-selected FFVP intervention schools in Indiana. Anonymous questionnaires were completed late in the 2011-2012 academic year. Multilevel logistic regressions were used to determine associations between students' perceptions of program effects (4 close-ended items) and their preference toward the program. Content analysis was applied to a single open-ended item for program comments.RESULTSOver 47% of students reported greater intake of fruit and vegetables due to FFVP, and over 66% reported liking the program. Student-reported program effects were positively associated with preference for the program (P < 0.01). Themes that emerged during analysis of 3,811 comments, included, students liked: the opportunity to try different kinds of fruit and vegetables, types and flavors of fruits served, and benefits of eating fruit. Fewer students liked the types of vegetables and their benefits. A small group disliked the program citing poor flavor of vegetables and quality of fruits. Important suggestions for the program include serving more dipping sauces for vegetables, cooking vegetables, and providing a greater variety of produce.CONCLUSIONSThe degree that students liked FFVP may predict the program's effects on fruit and vegetable intake. FFVP may become more acceptable to students by incorporating their suggestions. Program planners should consider these options for achieving program goals.

Students’ Feedback to Improve the USDA Fresh Fruit and Vegetable Program (FFVP) in Indiana

Objective: To identify salient student responses to program fruit and vegetables (FV) and formulate recommendations. Design, Setting and Participants: FFVP is a federallyfunded free-FV distribution program. Students receive FV as snacks at program schools. Data were previously collected in classrooms from 4-6th graders in 32 randomly-selected Indiana FFVP-schools during academic year 2011-12. Volunteers completed anonymous post-program questionnaires with an open-ended item, ‘‘Do you have any comments to make about FFVP?’’ Outcome Measures and Analysis: Content analyses were applied to 800 responses that were randomly sampled from 2086 responses. Responses were analyzed to identify themes then summarized within theme. Results: Among responses, 40% pertained to overall program attributes, 33% to fruitand 19% to vegetables served in FFVP, with 8% unrelated random comments.Within fruit responses, students most frequently reported liking program fruitswith either no reason given (27.4%),flavor (tasty/juicy/ sweet:18.5%), or because the program provided types they liked (strawberries/apples; 12.3%).Only 1.1% reported disliking fruit, while 40.7% suggested serving fruit more frequently, and greater variety. Within vegetable responses, studentsmost commonly reported liking vegetables because, either they are healthy for the body (5.7%), or they like certain types of vegetables (carrots/lettuce; 22.8%), anddisliking vegetables for either no reason (17.9%) or flavor (nasty/ weird-tasting/gross; 19.9%). They suggested vegetable service include dipping sauce (14.8%) and more variety (18.9%). Conclusions and Implications: Student reports herein (that they like fruit) help explain why this intervention improves fruit intake. Program planners should consider adopting students’ salient suggestions to improve the taste of vegetables by service with dipping sauces and providing a wide variety of mild-flavored vegetables. Funding: None.

The Effect of the Fresh Fruit and Vegetable Program on Childhood Obesity

AbstractThis paper investigates how the Fresh Fruit and Vegetable Program (FFVP), a nutrition assistance program that provides funding for the distribution of free fresh fruits and vegetables to students in participating schools, affects childhood obesity using a panel data set of Arkansas public schoolchildren with two different approaches. First, we combine matching methodology and difference‐in‐differences (DID) analysis. Second, we use the synthetic control method to compare each FFVP participating school to a similar, albeit synthetic, control school. Both analyses show that FFVP program causes an economically meaningful reduction in the obesity outcome of participating children.

One‐year and Two‐year Effects of The USDA Fresh Fruit and Vegetable Program (FFVP) on Students' Fruit and Vegetable Intake Frequency and Variety

FFVP is a federally‐funded free fruit (F) and vegetable (V) distribution program. Students in qualified elementary schools receive fresh FV as snacks at school. Most previous studies addressed the program over 1‐year. This study examined both 1‐year and 2‐year effects of FFVP on students' FV intake frequencies and variety. Data were previously collected from students in 20 intervention schools and 4 control schools, matched by propensity score, during 2010‐2012 school years. Students reported their F and V intake frequencies from the previous day. Students also reported whether they ate more than 1 kind of F and more than 1 kind of V every day. These dependent variables were compared over 3 times (pretest, 1‐year posttest, and 2‐years posttest) using hierarchical linear regression to test the difference between students' total F intake frequency, total V intake frequency, frequency of students eating more than 1 kind of F, and more than 1 kind of V after the 1‐ and 2‐year program periods. Results indicated that students ate F more often after 1 year (difference 0.35 times/day, p=0.003) and 2 years (difference 0.59 times/day, p=0.001) of intervention. No improvement was found in intervention students' V intake frequency over time. No change was found in the proportion of students that ate a variety of either F or V. No change was found in F or V intake frequencies and percent of students that ate a variety of F or V daily in control schools over time (p&gt;0.05). Thus, FFVP only improved F intake frequency during the implementation period. Reasons for no improvement in V intake frequency, F variety, and V variety over time need more study.

Status of the Fresh Fruit and Vegetable Program – 4 Years since Expansion

The United States Department of Agriculture (USDA) provides funding for the Fresh Fruit and Vegetable Program (FFVP) across the US with the goal to create healthier food environments in lower‐income elementary schools. Four years of data collected from 2009‐10 to 2012‐13 by the Bridging the Gap program from more than 2,200 public elementary schools participating in the National School Lunch Program were used to examine trends in FFVP participation. In 2012‐13, 36% of schools participated in the program, compared to 26% in 2009‐10. Schools with more low‐income students, with smaller enrollment, having a dietitian on staff and participating in the USDA's Team Nutrition program had significantly greater odds of participation in the FFVP. Presence of a full service kitchen was not associated with FFVP participation. Schools with dietitian on staff saw a 41% increase in participation from 2009‐10 to 2012‐13, compared to a 32% increase in schools with no dietitian. Although Team Nutrition schools started off with lower rates of participation, participation in non‐Team Nutrition schools increased at a higher rate in the last two years of reporting. Rates of participation have increased at similar rates among schools of different sizes. FFVP participation has increased in elementary schools over four years and additional resources such as having a dietitians on staff, participation in USDA's Team Nutrition programs, and a smaller school size are likely facilitators for FFVP participation.

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

BackgroundFewer 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. ObjectiveThe evaluation assessed FFVP effects on student F/V consumption and total energy intake in and out of school. DesignThe 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/settingParticipants were 4,696 students (grades 4 to 6) from 214 elementary schools in 16 randomly selected states. Statistical analyses performedAnalysis proceeded via multivariate regression, comparing adjusted mean student intake in schools just above and just below the funding cutoff. ResultsAdjusted 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. ConclusionsThe FFVP increases child fresh and total F/V intake in school, and fresh F/V intake outside of school.

Regression Discontinuity in Prospective Evaluations

While regression discontinuity has usually been applied retrospectively to secondary data, it is even more attractive when applied prospectively. In a prospective design, data collection can be focused on cases near the discontinuity, thereby improving internal validity and substantially increasing precision. Furthermore, such prospective application of regression discontinuity will often allow better understanding of the selection process, further increasing precision. As a result, regression discontinuity’s scope for application is considerably broadened in the prospective context. We demonstrate these ideas with an impact evaluation of the USDA Food and Nutrition Service’s Fresh Fruit and Vegetable Program (FFVP).

2010–2011 USDA fresh fruit and vegetable program (FFVP) improved Indiana elementary students’ consumption of fruit

U.S. children's fruit (F) and vegetable (V) consumption falls below recommendations. FFVP is a national program that addresses this problem. The FFVP 2010–11 in Indiana was evaluated to examine changes in students’ F and V intake using a quasi‐experimental, pre‐posttest design at 38 intervention and 8 control elementary schools with a 60 item questionnaire (4th–6th grades, n=11 138). Food intake frequencies (times/day) were grouped into 9 categories: F (in school, outside of school, total, 3 items each), V (in school, outside of school, total, 7 items each), and low nutrient density foods (LN) (in school, outside of school, total, 6 items each). The difference in daily F and V intake frequency between intervention and control overtime were determined with multilevel negative binomial regression using grade, gender, race, ethnicity and free/reduced lunch rate as covariates, post‐hoc tests were used to examine significant pairwise comparisons. Significant program by time interactions were found for total F (p=0.031) and total F in school (p=0.012) but not outside school (p=0.149). FFVP increased intake frequency of TF in intervention (p=0.038) but not in control (p=0.075) students. Total V and total LN food intake frequency did not change (FFVP × time, p=0.58 and 0.55, respectively). These data indicated FFVP may improve children's health. Further steps are needed to improve V consumption and reduce intake of LN food.