School Fruit Research Articles

Systematic review of school and community-based fruit and vegetable interventions for minority children

Systematic review of school and community- based fruit and vegetable interventions for minority children Sarah E Rush, Adam P Knowlden Department of Health Science, The University of Alabama, Tuscaloosa AL, USA Background: Schools and communities provide effective environments to change health behaviors in children and adolescents, particularly among minority populations. The purpose of this investigation was to systematically analyze community and school-based interventions aimed at increasing fruit and vegetable intake (FVI) among minority children. Methods: In collecting materials for this review, a search of CINAHL, MEDLINE, ERIC, Academic Search Premier, and Cochrane Central Register of Controlled Trials was conducted for articles spanning January 2003 to November 2013. The data extraction covered three phases, resulting in a total of eleven interventions that met the specified inclusion criteria. Results: Among the studies identified, ten interventions produced significant outcomes on observed variables. The majority of the programs incorporated multicomponent approaches aimed at increasing FVI and antecedents of FVI behavior. Eight of the interventions applied social cognitive theory, one reported use of other theories, and two did not apply theory. None of the interventions reviewed employed process evaluation. Conclusion: While both school and community-based interventions utilized over the past decade have separately shown significant impacts on changing dietary behaviors in children, community members and organizations can serve as supplementary approaches to partner with schools and design even more successful interventions based on these combined resources. School and community-based interventions have had a great deal of success in impacting self-efficacy levels as well as actual eating behaviors in children; however, the school and community-based interventions reviewed both noted lack of resources as a limitation. Therefore, combining these resources has the potential to help create more high-quality studies from which to draw evidence-based conclusions on the most effective means of impacting health behaviors among minority children in the school and community settings. Keywords: children, fruit and vegetable, interventions, minority, social cognitive theory, goal setting

Chefs move to schools. A pilot examination of how chef-created dishes can increase school lunch participation and fruit and vegetable intake

To demonstrate the feasibility of introducing a main dish designed by a professional chef in the National School Lunch Program and to document the impact on child participation, a chef was recruited to design pizza to be served in an upstate New York school district. The pizza was designed to meet both the cost and ingredient requirements of the NSLP. High school students were significantly more likely to select the pizza prepared by the chef. While the chef had no significant impact on main dish consumption given selection, more students took a vegetable and vegetable consumption increased by 16.5%. This pilot study demonstrates the plausibility of using chefs to boost participation in the school lunch program, and potentially increase nutrition through side selection, among high school students.

Finger Fruits: Pre-Sliced Fruit in Schools Increases Selection and Intake

Background: It is often assumed that children avoid fruit in school cafeterias because of higher relative prices and a preference for other foods. Laddering interviews reveal that younger children with small mouths or braces find whole fresh fruit difficult to eat. Older girls avoid it because it is messy and unattractive to eat.Purpose: To determine if offering pre-sliced fruit would increase the selection and intake of fruit among middle school students.Design: Three out of six middle schools were randomly given commercial fruit slicers and instructed to use them when students ordered apples. The selection and consumption of sliced apples was compared to selection and consumption of whole apples in control schools.Setting/Participants: Cafeterias in six public middle schools in Wayne County, New York. All students who ordered a lunch on days when data was collected. Intervention: In the fall semester of 2011, treatment schools were given a standard commercial fruit slicer and instructed to use it when students requested apples. Production and waste measurements were taken by trained researchers.Main Outcome Measures: Apple and other fruit sales, percentage wasted, and consumed.Results: Apple sales increased by 41% and consumption increased by 17%.Conclusions: Using the behavioral economics principle of convenience, this study shows that sliced fruit is more appealing than unsliced fruit, simply due to eating convenience and neatness. Opportunities exist for identifying effective applications of convenience and other environmental changes that promote healthy eating behavior and decrease waste.

Enhancing nutritional environments through access to fruit and vegetables in schools and homes among children and youth: a systematic review.

BackgroundLow fruit and vegetable (FV) consumption is one of the top 10 global risk factors for mortality, and is related to increased risk for cancer, cardiovascular disease and diabetes. Many environmental, sociodemographic and personal factors affect FV consumption. The purpose of this review is to examine the effects of interventions delivered in the home, school and other nutritional environments designed to increase FV availability for five to 18-year olds.MethodsThe search included: 19 electronic bibliographic databases; grey literature databases; reference lists of key articles; targeted Internet searching of key organization websites; hand searching of key journals and conference proceedings; and consultation with experts for additional references. Articles were included if: in English, French and Spanish; from high-, middle-, and low-income countries; delivered to anyone who could bring about change in FV environment for 5 to 18 year olds; with randomized and non-randomized study designs that provided before-after comparisons, with or without a control group. Primary outcomes of interest were measures of FV availability.ResultsThe search strategy retrieved nearly 23,000 citations and resulted in 23 unique studies. Interventions were primarily policy interventions at the regional or state level, a number of curriculum type interventions in schools and community groups and a garden intervention. The majority of studies were done in high-income countries.The diversity of interventions, populations, outcomes and outcome measurements precluded meta-analysis. The most promising strategies for improving the FV environment for children are through local school food service policies. Access to FV was successfully improved in four of the six studies that evaluated school-based policies, with the other two studies finding no effect. Broader state or federally mandated policies or educational programs for food service providers and decision makers had mixed or small impact. Similarly family interventions had no or small impact on home accessibility, with smaller impact on consumption.ConclusionsThe studies have high risk of bias but more rigorous studies are difficult to impossible to conduct in naturalistic settings and in policy implementation and evaluation. However, there are promising strategies to improve the FV environment, particularly through school food service policies.

Accessibility over availability: associations between the school food environment and student fruit and green vegetable consumption.

No national studies have examined associations between (1) school food availability and accessibility and (2) secondary student fruit and vegetable (FV) consumption. This article uses 5 years of nationally representative data from secondary school students to examine associations between the school food environment and student fruit and green vegetable consumption. From 2008 to 2012, cross-sectional, nationally representative data from US middle and high school students were collected annually on self-reported fruit and green vegetable consumption. Each year, data from administrators at each relevant school were collected on food item availability (any venue) and accessibility (total number of school sources). Data were obtained from 10,254 eighth-grade students in 317 schools and 18,898 tenth- and 12th-grade students in 518 schools. Associations were estimated by multi-level models controlling for student- and school-level characteristics. Availability showed minimal association with student consumption. Candy/regular-fat snack accessibility was associated negatively with middle school fruit consumption. Salad bar availability and accessibility were positively associated with middle school green vegetable consumption; FV accessibility was associated positively with high school fruit and green vegetable consumption. Significant associations were consistent across student racial/ethnic and socioeconomic groups. Forthcoming USDA nutrition standards for school foods and beverages sold outside of reimbursable meal programs should result in the removal of school candy/regular-fat snacks. In deciding which items to make available under the new standards, schools should consider increasing the number of FV sources-including salad bars-thereby potentially increasing student FV consumption.

The FIT Game: preliminary evaluation of a gamification approach to increasing fruit and vegetable consumption in school

ObjectiveIncentive-based interventions designed to increase fruit and vegetable (FV) consumption tend to yield positive, short-term outcomes. Because consumption most often returns to baseline levels when incentives are removed, sustainable long-duration interventions may be needed to impact public health. Anticipating that low-cost interventions will be more appealing to schools, the present study explored a low-cost, game-based intervention. MethodAn alternating-treatments design was used to evaluate the effects of the FIT Game on objectively measured FV consumption in one elementary school (n=251) in Utah. During the Fall 2013 semester, game-based rewards were provided to heroic characters within a fictional narrative read by teachers on days when the school, as a whole, met a fruit or vegetable consumption goal in accord with the alternating-treatments design. ResultsOn intervention days, fruit and vegetable consumption increased by 39% and 33%, (p<0.01, p<0.05; binomial tests), respectively. Teacher surveys indicated that students enjoyed the game and grade 1–3 teachers recommended its use in other schools. ConclusionThis game-based intervention provides a promising step towards developing a low-cost, effective, and sustainable FV intervention that schools can implement without outside assistance.

More apples fewer chips? The effect of school fruit schemes on the consumption of junk food

ObjectivesUsing Italian data, we evaluate the effects on the consumption of unhealthy snacks of a European Union-wide campaign providing fruit and vegetables to school children and promoting healthy diet habits. MethodsWe use scanner data of supermarket sales in the city of Rome. Using a difference-in-difference approach, we compare the sales of these snacks before and after the campaign in supermarkets located within a 500m radius of schools that participated to the program (the treated group) and in supermarkets located outside that radius (control group). ResultsWe find that the campaign has been effective in reducing the increase in the sales of unhealthy snacks in treated stores – relative to control stores – only in the case of regular stores, which tend to locate in the wealthier areas of Rome. No effect is found, instead, for discount stores, where people with a higher risk of developing obesity are more likely to shop. ConclusionsOur results suggest that the European School Fruit campaign has restrained the consumption of junk food in the sub-group of the population (wealthier families) who is less likely to be exposed to overweight and obesity problems, but has not been effective at all for the sub-group more at risk.

Abstract P409: Assessing public health nutrition policies using a novel framework across 30 European countries: Lessons for the USA?

Background: Countries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions is potentially bewildering. We therefore aimed to map existing public health nutrition policies and identify their perceived effectiveness, in order to inform future evidence-based diet strategies. Methods: Mapping exercise: We created a public health nutrition policy database for 30 European countries (EU 27 plus Iceland, Norway and Switzerland), by summarising policy documents, grey literature, web searches and advice from topic experts. National nutrition policies were then classified using the marketing “4Ps” approach: Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling and health education) and Place (schools, workplaces, etc.) Policy interviews: We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies. Results Product: Voluntary reformulation of foods, (especially salt, sugar and total fat) is widespread but with questionable impact. Denmark, Austria, Iceland and Switzerland have trans fats bans. Twelve countries regulate maximum salt content in specific foods. Price: EU School Fruit Scheme subsidies are almost universal, with variable implementation. Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products. Promotion: Dialogue, recommendations, nutrition guidelines, information and education campaigns are widespread (all 30 countries). Labelling information is widespread, but variable. Restrictions on marketing to children are widespread but mostly voluntary. Place: Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens (e.g. vending machines). Comparative effectiveness: Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but politically much more challenging. Implications: Public health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. However, the “4Ps” framework potentially offers a structured and comprehensive categorisation. Most European countries are active in nutrition policy. However, exemplars are few, including Finland, Norway, Iceland, Denmark, Hungary, Portugal and the UK. Do these offer any useful lessons for US states addressing similar challenges? In conclusion, fiscal and regulatory nutrition policies appear potentially powerful and should be considered across Europe, and perhaps across the US?

Associations between socioeconomic, parental and home environment factors and fruit and vegetable consumption of children in grades five and six in British Columbia, Canada

BackgroundRegular fruit and vegetable (FV) consumption has been associated with reduced chronic disease risk. Evidence from adults shows a social gradient in FV consumption. Evidence from pre-adolescent children varies and there is little Canadian data. This study assessed the FV intake of school children in British Columbia (BC), Canada to determine whether socio-economic status (SES), parental and the home environment factors were related to FV consumption.MethodsAs part of the BC School Fruit and Vegetable Nutrition Program, 773 British Columbia fifth-and sixth-grade school children (Mean age 11.3 years; range 10.3-12.5) and their parents were surveyed to determine FV consumption and overall dietary intake. Students completed a web-based 24-hour dietary food recall, and a student measure of socio-economic status (The Family Affluence Scale). Parents completed a self-administered survey about their education, income, home environment and perceptions of their neighbourhood and children’s eating habits. Correlations and multiple regression analyses were used to examine the association between SES, parental and home environment factors and FV consumption.ResultsApproximately 85.8% of children in this study failed to meet minimum Canadian guidelines for FV intake (6 servings). Parent income and education were not significantly associated with child FV consumption but were associated with each other, child-reported family affluence, neighbourhood environment, access to FV, and eating at the table or in front of the television. Significant positive associations were found between FV consumption and child-reported family affluence, meal-time habits, neighbourhood environment and parent perceptions of the healthiness of their child’s diet; however, these correlations were weak (ranging from .089-.115). Multiple regression analysis showed that only child-reported family affluence significantly predicted FV consumption (std-β = 0.096 95% CI = 0.01 to 0.27).ConclusionsThe majority of children in our study were not meeting guidelines for FV intake irrespective of SES, parent perceptions or home environment, making this a population wide concern. An almost trivial socio-economic gradient was observed for the child-reported SES measure only. These results are consistent with several other studies of children. Longitudinal research is needed to further explore individual and social factors associated with FV consumption in childhood and their development over time.

Free school fruit: can an extra piece of fruit every school day contribute to the prevention of future weight gain? A cluster randomized trial

BackgroundSeveral school fruit programs are initiated with the aim to improve diet and thereby contribute to reduce the prevalence of overweight. To date, no published studies have demonstrated that school fruit schemes do prevent overweight.ObjectiveThe aim of the present study was to assess if increased consumption of fruits and vegetables, due to free school fruit, have an impact on future weight status.DesignAn intervention study including 10- to 12-year-old children from nine schools in two Norwegian counties (Hedmark and Telemark) participating in the Norwegian School Fruit Program for free during the school year 2001/2002 and children from 29 control schools. Follow-up studies were performed in 2005 and 2009. The cohort includes 1950 pupils (984 boys, 966 girls) at baseline, 1,602 participants in 2005 and 320 participants in the 2009 survey, of which 282 also had participated in 2005.ResultsIn 2005, there was no significant difference between the free fruit group and the control group regarding weight status, Body mass index, or perceived weight status. In 2009, a significant difference in prevalence of overweight was observed (15% vs. 25%, p=0.04). In the crude logistic analysis, the OR for being overweight was 0.52 (95% CI: 0.28–0.97) for the intervention group compared to controls. When adjusting for school, sex, grade level and parental education, the association was no longer statistically significant.ConclusionsThese results indicate that free school fruit might contribute to prevent future excessive weight gain. However, the study results are limited by low participation rate.

Efficacy of a Minimal Dose School Fruit and Vegetable Snack Intervention

Efficacy of a Minimal Dose School Fruit and Vegetable Snack Intervention Fruits and vegetables are important to health but the majority of Canadian children are not consuming enough of them. The provision of free fruit and vegetables at school over a school year significantly increases fruit and vegetable intake but the costs may prohibit adoption or sustained implementation of this approach. To address the issue of cost we evaluated the impact of a minimal dose free school fruit and vegetable snack intervention (4 months of intervention, 14 servings, 2 times/week every second week).

Determinants of Fruit, Vegetable, and Dairy Consumption in a Sample of Schoolchildren, Northern Serbia, 2012

IntroductionInsufficient intake of fresh fruits, vegetables, and dairy products among children is a serious nutrition-related concern. The aim of our study was to determine behavioral and environmental factors that influence fruit, vegetable, and dairy consumption among Serbian schoolchildren.MethodsWe used 24-hour recall to measure fruit, vegetable, and dairy intake of schoolchildren (N = 212) aged 8 to 11 years from 2 elementary schools in a local community in Serbia. We evaluated potential determinants of intake by using a 48-item questionnaire that asked about children’s behaviors, perceptions of others’ expectations and behaviors, reinforcement of children’s behaviors, and availability of fruits, vegetables, and dairy at home and school. Children completed written questionnaires during 1 school class under teacher supervision. Binary logistic regression was used to analyze determinants of fruit, vegetable, and dairy intake. ResultsNegative predictors of fruit intake were expectations from teacher and parents (P <.001) to eat fruit and availability of fruit in school. Vegetable intake was positively related to paternal modeling behavior (P <.001) and availability of vegetables at home (P = .04). Dairy intake was positively influenced by parental reinforcement (P = .03). ConclusionVarious personal and environmental factors are associated with children’s intake of fruits, vegetables, and dairy. Interventions to promote fruit, vegetable, and dairy consumption in Serbian schoolchildren should focus on modeling and reinforcement by parents and teachers and increasing availability at school and at home.

Applying Process Mapping and Analysis as a Quality Improvement Strategy to Increase the Adoption of Fruit, Vegetable, and Water Breaks in Australian Primary Schools

Over the past decade, public health policy in Australia has prioritized the prevention and control of obesity and invested in programs that promote healthy eating-related behaviors, which includes increasing fruit and vegetable consumption in children. This article reports on a study that used process mapping and analysis as a quality improvement strategy to improve the delivery of a nutrition primary prevention program delivered in primary schools in New South Wales, Australia. Crunch&Sip® has been delivered since 2008. To date, adoption is low with only 25% of schools implementing the program. We investigated the cause of low adoption and propose actions to increase school participation. We conducted semistructured interviews with key stakeholders and analyzed the process of delivering Crunch&Sip to schools. Interviews and process mapping and analysis identified a number of barriers to schools adopting the program. The analyses identified the need to simplify and streamline the process of delivering the program to schools and introduce monitoring and feedback loops to track ongoing participation. The combination of stakeholder interviews and process mapping and analysis provided important practical solutions to improving program delivery and also contributed to building an understanding of factors that help and hinder program adoption. The insight provided by this analysis helped identify usable routine measures of adoption, which were an improvement over those used in the existing program plan. This study contributed toward improving the quality and efficiency of delivering a health promoting program to work toward achieving healthy eating behaviors in children.

Evaluating free school fruit: results from a natural experiment in Norway with representative data.

To assess impacts of the nationwide Norwegian School Fruit Scheme (NSFS) using nationally representative data. The NSFS is organized such that primary-school children (grades 1-7) are randomly assigned to one of three school fruit arrangements: (i) the child receives one free fruit or vegetable per day; (ii) the child is given the option to subscribe to one fruit or vegetable per day at a subsidized price; and (iii) the child attends a school that has no school fruit arrangement. Data from an Internet survey are used to compare child and parental fruit and vegetable intakes across the three NSFS groups focusing mainly on groups (i) and (iii). The analysis was conducted using multivariate regression techniques. Parents of primary-school children (n 1423) who report on behalf of themselves and their children. Children who receive free school fruit eat on average 0·36 more fruit portions daily - or 25·0 % more fruits - than children who attend schools with no fruit arrangement (P < 0·001). Moreover, parents of children who receive free school fruit eat on average 0·19 more fruit portions daily - or 12·5 % more fruits - than parents of children who attend schools with no fruit arrangement (P = 0·040). No significant associations were found between the NSFS and the vegetable intakes of children and their parents. The study shows, using nationally representative data, that free school fruit is associated with increased child fruit intake and that it may also affect parental fruit intake.

OP16 Utilising a Novel Framework to Assess Public Health Nutrition Actions Across 30 European Countries (EuroHeart II Project)

BackgroundEuroHeart II is a European programme designed to inform cardiovascular health strategies across Europe. Our project examines the role of food policies in cardiovascular disease prevention, including the development and...

Fresh Fruit &amp; Vegetable Program Participation in Elementary School Influences Fruit and Vegetable Selection in Middle School

Fresh Fruit &amp; Vegetable Program Participation in Elementary School Influences Fruit and Vegetable Selection in Middle School

Elementary School Children’s Fruit and Vegetable Consumption in Schools with and without a Farm to School Program

Continued on page S75 Results: Seven questions were eliminated from the set of 48 items after the cognitive interviews, 5 due to multiple potential interpretations and 2 for redundancy. Seven questions were adjusted for clarification. These items will undergo a 2nd round of cognitive interviewing. Conclusions and Implications: After cognitive interviewing, 14 of 48 items (29%) had to either be eliminated or modified. Without cognitive testing many items in the survey may have been misinterpreted, resulting in inaccurate data and unreliable results. This study highlights the importance of using cognitive interviewing as an integral part of survey development. Funding: None.

Pre-Sliced Fruit in School Cafeterias

<h3>Background</h3> It is often assumed that children avoid fruit in school cafeterias because of higher relative prices and preferences for other foods. Interviews with children reveal that eating whole fresh fruit can be difficult for those with small mouths or braces. Older girls find whole fruits messy and unattractive to eat. <h3>Purpose</h3> To determine the effect of offering pre-sliced fruit in schools on selection and intake. <h3>Design</h3> Three of six schools were assigned randomly to serve apples in slices. Three control schools served apples whole. Selection, consumption, and waste of apples were measured prior to and during treatment. <h3>Setting/participants</h3> Cafeterias in six public middle schools in Wayne County NY in 2011. Participants included all students who purchased lunch on days when data were collected. <h3>Intervention</h3> Treatment schools were provided with a standard commercial fruit slicer, and cafeteria staff members were instructed to use it when students requested apples. Trained researchers recorded how much of each apple was consumed and how much was wasted in both control and treatment schools. <h3>Main outcome measures</h3> Daily apple sales, percentage of an apple serving consumed per student, and percentage of an apple serving wasted per student. <h3>Results</h3> Data were analyzed in 2012. Schools that used fruit slicers to pre-slice fruit increased average daily apple sales by 71% compared to control schools (<i>p</i><0.01). The percentage of students who selected apples and ate more than half increased by 73% (<i>p</i>=0.02) at schools that served pre-sliced fruit, and the percentage that wasted half or more decreased by 48% (<i>p</i>=0.03). <h3>Conclusions</h3> Sliced fruit is more appealing to children than whole fruit because it is easier and tidier to eat. This study applies the principle of convenience from behavioral economics and provides an example of a scalable, low-cost environmental change that promotes healthy eating and decreases waste.

School nutritional capacity, resources and practices are associated with availability of food/beverage items in schools.

BackgroundThe school food environment is important to target as less healthful food and beverages are widely available at schools. This study examined whether the availability of specific food/beverage items was associated with a number of school environmental factors.MethodsPrincipals from elementary (n = 369) and middle/high schools (n = 118) in British Columbia (BC), Canada completed a survey measuring characteristics of the school environment. Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman’s Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes.ResultsIn elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR = 6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR = 4.54 and OR = 3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR = 5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/beverage items available at school: chocolate candy (OR = .80) and sugar-sweetened beverages (OR = .76).ConclusionsSchool nutritional capacity, resources, and practices were associated with the availability of specific food/beverage items in BC public schools. Policies targeting the school environment are increasingly being considered as one of the strategies used to address childhood obesity, as a result it is important to further understand the factors associated with the availability of specific food/beverage items at school.

A cluster-randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato.

The present study aimed to determine whether a multi-component school-based intervention can maintain children's fruit and vegetable intake post eligibility for free school fruit and vegetables. A random sample of fifty-four English primary schools was randomised to receive the 10-month intervention Project Tomato, a multi-component theory-based intervention, or the control. Each group consisted of twenty-seven schools. Children's intake of fruit and vegetables is below recommendations. The English School Fruit and Vegetable Scheme has a short-term impact on intake while children are eligible for the scheme. Dietary measurements were collected from 658 Year 2 pupils aged 7-8 years at baseline and at follow-up 20 months later. Following an intention to treat analysis, the intervention as delivered compared with the control had no impact on the intake of fruit and vegetables (2 g/d, 95 % CI -23, 26 g/d) or on the number of portions of fruit (0.0 portions, 95 % CI - 0.3, 0.3) or vegetables (0.0 portions, 95 % CI - 0.2, 0.3) consumed daily by children. Intake of fruit and vegetables at school and home dropped by ≈ 100 g/d and 50 g/d, respectively, between baseline and follow-up in both the intervention and control groups. Implementation of the intervention was low, with associated lack of impact on fruit and vegetable consumption in children. Alternatives to the delivery of an intervention by teachers and parents are needed to improve the dietary intake of primary-school children.