university of wisconsin-eau claire getting children to eat more fruits & vegetables: what works?...

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Getting Children To Eat More Fruits & Vegetables:

What Works?

Getting Children To Eat More Fruits & Vegetables:

What Works?

Students: Tyler Christiansen, Judy Dickinson, Stephen Fisher, Lainee Hoffman, Stephanie Mabrey, Kevin Reinhold,

April Ross, and Laurelyn Wieseman

Faculty Mentors: Dr. Eric Jamelske and Dr. Lori Bica University of Wisconsin-Eau Claire

Economics & Psychology Departments

Chippewa Valley Center for

Economic Research & Development

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

OverviewOverview

Motivation FFVP Background Initial Impact on FV Intake

Impact on attitudes/behavioral intent and intake Explore repeated FV exposure Expanding the Reach of the FFVP

Questions and Discussion

IntroductionIntroduction Inadequate FV consumption (not 5-9 a day) Lots of less healthy alternatives Rising rates of childhood and adult obesity Significant health care concern, annual costs in the BILLIONS of $

IntroductionIntroduction Use school setting to address this very important issue

USDA created Fresh Fruit and Vegetable Snack Program (FFVP) to improve nutrition and combat obesity (2002)

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Provides funding for students in selected schools to receive a free FV snack 3-4 days a week through the year.

Elementary schools with at least 50% free/reduced population

Budget guidelines allow spending of $50-75 per student per year

Up to 10% of funds can be used for labor/capital expenses

Schools choose how many days/week, when/where to serve FV snacks, and how much, if any, nutrition education to include.

The Fresh Fruit & Vegetable ProgramThe Fresh Fruit & Vegetable Program

The Fresh Fruit & Vegetable ProgramThe Fresh Fruit &

Vegetable Program USDA http://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htm

Wisconsin Department of Public Instruction http://dpi.wi.gov/fns/ffvp.html

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Wisconsin received FFVP funding in 2006 and the FFVP was expanded to all 50 states plus the District of Columbia, Guam, Puerto Rico and Virgin Islands through the 2008 US Farm Bill.

Expanding the FFVP nationwide involved significant cost, as funding increased from $18.9 million for 2007-08 to $50 million for 2008-09.

Given the sizeable resources committed to the FFVP, it is important to ascertain the degree to which it has achieved the stated purpose and goals.

The Fresh Fruit & Vegetable ProgramThe Fresh Fruit & Vegetable Program

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

4 Western Wisconsin elementary schools– 2 program (n = 124)– free FV morning snack three or four days/week– 2 matched control (n = 134), no free FV snack– 4th and 5th grade students– pre-test/post-test/post-test experimental design

Do students eat the fruit and vegetable snacks?– What did you eat yesterday at school for morning snack?

2008-09 Evaluation Process2008-09 Evaluation Process

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

ConclusionConclusion

The FFVP Works!

All else equal, the FFVP ↑ average FV intake among program students by about 1/2 serving (compared to control)

Program effect is limited to free access at morning snack

Students did not bring FV from home to eat on non-FFVP days

If students are provided with free FV with no alternatives

THEY EAT THEM!

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

2009-10 Research, Part I2009-10 Research, Part I Two Western Wisconsin elementary schools

One program school (n = 76)– Free afternoon FV snack three days/week

One matched control school (n = 110)– No free FV snacks

Pre-test/Post-test experimental design (three survey days each)

Does FFVP increase FV intake for school snack? Examine student attitudes and behavioral intent toward FV

Measure average daily FV snack consumption (3 survey days)

Morning and afternoon snack

Test difference between program and control students

Sample restricted to students who were present on all three survey days for both pre-test and post-test (n = 51, 78)

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

The average over three days averaged across all students

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

The average over three days averaged across all students

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Free afternoon snack on 2 days, early release on day 3 Apple (92%), Kiwi (84%)

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Never = 1 Sometimes = 2 Often = 3 Always = 4

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Never = 1 Sometimes = 2 Often = 3 Always = 4

1 2 3 4

1 2 3 4

1 2 3 4

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Never = 1 Sometimes = 2 Often = 3 Always = 4

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Never = 1 Sometimes = 2 Often = 3 Always = 4

1 2 3 4

1 2 3 4

1 2 3 4

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Never = 1 Sometimes = 2 Often = 3 Always = 4

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Never = 1 Sometimes = 2 Often = 3 Always = 4

1 2 3 4

1 2 3 4

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

The FFVP Works!The FFVP Works!

Compared to control students…

Program students increased FV intake for school snack

Program students reported increased willingness to try new FV at home and especially at school

Program students reported asking their parents to buy FV more often when they went shopping

FFVP did not influence willingness to choose FV for snack over chips, cookies or candy

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

2009-10 Research, Part II2009-10 Research, Part II

One Western Wisconsin elementary school (n = 76)

Daily afternoon snack behavior tracked by teacher

Do students eat the free FV snacks?

Explore repeated exposure to FV items

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Daily F&V Snack Track Daily F&V Snack Track

Monday, Tuesday and Thursday are free FV snack days

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Total FV eaten by students on free snack days, divided by the number of student days over the period (omit absences)

Ate none = 0 Tried = 0.25 Ate half = 0.5 Ate all =1

Ate none = 0 Tried = 0.25 Ate half = 0.5 Ate all =1

0.7970.757

0.854

0.592 0.636 0.6650.553 0.654

0.620 0.618

0.685

0.864

0.660 0.6370.709

0.870

0.938

0.858

0.776 0.782

0.604

0.740

0.683 0.630

0.654

0.640

0.750

0.576

0.601 0.540 0.557

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

The FFVP…..The FFVP….. Program served more than twice as much fruit (66) as vegetables (29)

Program relied on available supply of fresh local apples (34)

Reasonable variety of F (8) V (10)

Apples and Oranges, Kiwi and Pear...Blueberries and Watermelon

Carrots, Celery and Cucumber…Pea Pods, Green Pepper and Jicama

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

WORKS!WORKS!

Students generally eat the free FV snacks

Students prefer fruit to vegetables

They didn’t grow tired of apples and apples and apples…An apple a day, keeps the doctor away!

Some evidence of developed FV preferences (likes/dislikes)

Tomatoes, Pea Pods, Green Peppers, Grapes, Pear

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

2009-10 Research, Part III2009-10 Research, Part III

One Western Wisconsin elementary school (n = 76)

Daily afternoon snack behavior tracked by teacher

Days when no free FV snack was provided

Do students bring FV snacks from home on non-FFVP days?

Various phases of incentives, reminders, modeling and praise

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Daily F&V Snack Track Daily F&V Snack Track

Wednesday and Friday are NOT free FV snack days

Non-Free Snack DaysNon-Free Snack Days Six distinct phases of study (October 2009 – May 2010)

Nothing Wall chart with stickers Small prizes Positive role modeling/praise Homework reminders

Phase One: 6 days Phase Two: 6 days Phase Three: 4 days Phase Four: 4 days Phase Five: 19 days Phase Six: 14 days 53 total days

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

FV brought from home by students on non-free snack days, divided by the number of student days over the period (omits absences)

Ate all or at least half = 1

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

Ate all or at least half = 1

Phase One: Baseline, no incentives

Phase Two: Stickers and wall charts

Phase Three: Stickers, wall charts and toy prizes

Phase Four: Back to baseline, no incentives (after winter break)

Phase Five: Toy prizes, modeling, praise and reminders, nothing

Phase Six: Toy prizes, modeling, praise and reminders

Nothing

Chart &

Stickers

Chart, Stickers & Toys

Nothing

Nothing

Reminders, Modeling/Praise & Toys

Nothing

Chart &

Stickers

Chart, Stickers & Toys

Nothing

Reminders & Modeling/Praise

Reminders, Modeling/Praise & Toys

Nothing

Chart &

Stickers

Chart, Stickers & Toys

Nothing

Reminders, Modeling/Praise & Toys

Reminders, Modeling/Praise & Toys

Nothing

Chart &

Stickers

Chart, Stickers & Toys

Nothing

Reminders, Modeling/Praise & Toys

Reminders, Modeling/Praise & Toys

The FFVP Works!The FFVP Works!

Toy PRIZES MATTER!

Homework reminders WORK!

Most successful when combined with POSITIVE MODELING & PRAISE!

A caring and dedicated teacher was able to get 70% of her students to bring FV snacks from home on a regular basis.

University of Wisconsin-Eau ClaireUniversity of Wisconsin-Eau Claire

The FFVP Works!The FFVP Works!

Framework for schools to expand the reach of the FFVP beyond the access to free FV provided as snacks in the classroom.

Feasible and affordable in terms of time, resources and money….SCHOOLS CAN DO THIS!

It seems to work EFFECTIVELY!

FV Brought from Home in AWESOME ClassFV Brought from Home in AWESOME Class

The FFVP

WORKS!The FFVP

WORKS!

Cost is $50 per student plus toy

Prizes and Praise

Benefit is

Priceless >

Questions?Questions?