Effectiveness of a Program to Increase Fruit and Vegetable Consumption

Introduction

Consuming an adequate intake of fruits and vegetables has been proposed as one way to reduce morbidity and mortality from heart disease and cancer (American Cancer Society, 1996; Deckelbaum et al., 1999; Ness, 1997). Fruits and vegetables contain several essential nutrients, such as vitamin C and folate, and other dietary factors, such as fiber and flavenoids, which have been linked to the prevention of various cancers and other chronic illnesses. In addition, obesity levels are lowest among those who have high intakes of fruits and vegetables (Produce for Better Health Foundation, 2001).

The U.S. Dietary Guidelines recommend that all people over the age of 2 years of age eat five to nine servings of fruits and vegetables every day (USDA, 1995). However, more than 75% of U.S. residents fail to meet these recommendations (Produce for Better Health Foundation, 2001). Americans are eating only about four servings of fruits and vegetables, including French fries and potato chips. Excluding these high-fat processed potato products, Americans are eating only about 3.6 servings each day. Only one in five Americans meets the 5-A-Day minimum requirement for fruits and vegetables. Only 13% of American families, 22% of single persons, 27% of "empty nesters," and 39% of the elderly are eating the minimum recommended five servings per day of fruits and vegetables. Only nine out of 10 teen girls (89%) and 96% of children ages 2-12 do not eat five servings per day.

Project Description

Recognizing that the majority of people consume an inadequate intake of fruits and vegetables, a program was developed with the goal of increasing consumption. This program arose from a partnership between the Expanded Food and Nutrition Education Program (EFNEP) and the South East Produce Council (SEPC).

EFNEP targets those with fewer economic and social resources, those who might be food insecure, and those at vulnerable life cycle stages. Through EFNEP, participants learn how to make good choices to improve the nutritional quality of the meals they serve their families. They participate in a series of at least 12 lessons based on the Food Guide Pyramid and the Dietary Guidelines for Americans. The hands-on, learn-by-doing approach allows the participants to gain the practical skills necessary to make positive behavior changes.

The SEPC is a non-profit organization made up of growers/shippers, wholesalers, retailers, brokers, institutional food service operators, distributors, the media, and industry product or service providers. The organization is committed to serving its members and the community, and they support charitable causes in Southeastern communities.

Through the partnership, EFNEP's educational lessons were enhanced to focus more on fruit and vegetables. The SEPC provided information on different produce items, which includes the nutritional value and health benefits of the item along with proper selection and handling. Fruit and vegetable recipes were developed and tested in the Food Science and Human Nutrition sensory evaluation/food product development lab at Clemson University. These recipes were used in the hands-on portion of the educational classes provided by EFNEP educators.

One of the unique components of this program involves funding provided by the SEPC for the purchase of a seasonal produce item that would be "featured" in the educational lessons. The SEPC provides a coupon to be used by the educators and to be left with the family redeemable at their preferred local supermarket. The first set of coupons (for collards) was distributed and redeemed during the months of February and March. The second set of coupons was for sweet potatoes, and was distributed during November and December.

Evaluation

The program includes a pre-test and a post-test evaluation to assess preferences and changes in level of consumption of fruits and vegetables. The entry survey revealed that the top four fresh fruit items the participants purchased were apples (80.6%), oranges (70.4%), grapes (68.5%), and bananas (65.7%). The top fresh vegetable items were cabbage (48.1%), corn (42.6%), collards (35.2%), lettuce (25.0%), carrots (25.0%), and potato (25.0%).

Before the program, the participants ate 2.7 servings of fresh fruits and vegetables in a day. Approximately one third of the participants (33.3%) ate three servings of fresh fruits and vegetables in day, and 27.8% ate two servings of fresh fruits and vegetables in day.

About half of the participants (45.4%) were aware of the 5-A-Day program, and half of the participants (53.7%) were not aware of the 5-A-Day program before the program. The top two fruits that participants never had but would like to try were mango (40.4%) and kiwi (33.0%). The top four vegetables that participants never had but would like to try were eggplant (21.1%), asparagus (17.4%), mushrooms (39.2%), and squash (7.4%).

The results indicate that about three quarters of the participants (74.0%) consume more fruits and vegetables since starting the program. After the program, the participants ate 3.2 servings of fresh fruits and vegetables in a day. About one third of the participants (31.6%) ate four servings of fresh fruits and vegetables in day and 25.3% ate three servings of fresh fruits and vegetables in day. About one quarter of the participants (24.2%) ate two servings of fresh fruits and vegetables in day. Almost all participants (94.7%) thought this program was helpful in educating them about the benefits of eating fresh fruits and vegetables. Paired T-tests results on the question "On average, how many servings of fresh fruits and vegetables do you eat in a day" showed that after the program, the participants significantly increased number of servings of fresh fruits and vegetables eaten in a day (P<.01).

Conclusion

The program is an innovative way to help participants acquire knowledge, skills, attitudes, and behaviors necessary to improve their eating habits. Evaluation data shows that the program participants made a significant increase in their consumption of fruits and vegetables. In addition, through the administration of entry surveys, a baseline profile of the families' fresh produce purchases and consumption was developed. The knowledge base developed through this project can contribute to other education programs, and provide needed information for disease prevention and intervention planning.

References

American Cancer Society Advisory Committee on Diet, Nutrition, and Cancer Prevention. (1996). Guidelines on diet, nutrition, and cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. The American Cancer Society 1996 Advisory Committee on Diet, Nutrition, and Cancer Prevention. Cancer Journal for Clinicians, 46(6):325-41.

Deckelbaum, R. J., Fisher, E. A., Wintson, M., Kumanyika, S., Lauer, R. M., Pi-Sunyer, F. X., St. Jeor, S., Schaefer, E. J., & Weinstein, I. B. (1999). Summary of a scientific conference on preventive nutrition: Pediatrics to geriatrics. Circulation 1999;100(4):450-6.

Ness A. R., & Powles, J. W. (1997). Fruit and vegetables, and cardiovascular disease: A review. International Journal of Epidemiology, 26(1):1-13.

Produce for Better Health Foundation. (2001). Fruit and vegetable intake in the U.S. survey data and demographics. Available at: http://www.5aday.com/html/research/consumptionstats.php

U.S. Department of Agriculture, Agricultural Research Service, Dietary Guidelines Advisory Committee. (1995). Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, 1995.