By Jessica Thomson, Research Epidemiologist, USDA Agricultural Research Service & Lisa Tussing-Humphreys, Assistant Professor, Department Of Medicine, University Of Illinois at Chicago & University Of Illinois Cancer Center
Childhood obesity is a national public health threat with approximately 15 percent of children 2 to 19 years of age classified as overweight and 17 percent classified as obese. Once believed to be adult-onset conditions, hypertension, dyslipidemia, osteoarthritis, and Type 2 diabetes are now commonly seen in child populations. One strategy to fight childhood obesity, advocated by the pediatric medical community, is for children to eat the government-recommended daily amount for fruits (1.5 servings) and for vegetables (2 to 2.5 servings).
However, children’s unwillingness to try healthy foods, such as fruits and vegetables, has been given as the reason for their low consumption of these foods. Therefore, we conducted a fruit and vegetable snack-feeding trial to determine: (1) elementary school children’s familiarity with and willingness to try fruit and vegetable snacks; (2) if a school-based fruit and vegetable snack-feeding intervention can increase children’s familiarity with, and consumption of, fruits and vegetables; and (3) associations between familiarity, willingness to try, and consumption of fruits and vegetables.
The School Kids Access to Treats to Eat (SKATE) study was a school-based, fruit and vegetable snack-feeding trial conducted with students enrolled at a rural elementary school located in Mississippi. The participation rate for free or reduced school meals was 95 percent, although 100 percent of children at this school were eligible. All 4th- to 6th-grade children were invited to participate in the study. Fruit and vegetable snacks were offered three times per week in the six-week study period. The snacks consisted of 12 fruits (green and red apples, apricots, cantaloupe, red and green grapes, kiwis, mandarin, Clementine, and Navel oranges, pears, and tangerines) and five vegetables (broccoli, baby carrots, yellow squash, grape tomatoes, and zucchini).
Before beginning the study, we measured the children’s familiarity (recognition of and prior eating experience with) and willingness to try selected fruits and vegetables. Responses for willingness to try were recorded as “no,” “maybe,” and “yes” with higher scores corresponding to greater willingness to try a food.
The educational component of our study consisted of a short presentation in which the fruit or vegetable was named and fun facts about the food were shared with the children. Subsequently, the children were given time to eat the snack. Snack containers were weighed prior to distribution and after the snacking period to determine the amount eaten.
Our sample size consisted of 187 of the 214 (87 percent) 4th- to 6th-grade students enrolled at the rural elementary school. Prior to the study, children’s recognition ranged from 9 percent (apricot) to 100 percent (baby carrot and red grape); previous eating experience ranged from 46 percent (apricot) to 100 percent (red apple); willingness to try ranged from 30 percent (grape tomato) to 96 percent (red grape); and unwillingness to try ranged from 0 percent (red apple) to 5 percent (cantaloupe).
Average familiarity and willingness to try scores indicated that children recognized and had previous eating experience with most (80 percent) of the selected 12 fruits and vegetables, and were willing to try them. In general, if children had previous eating experience with a fruit or vegetable, they were more likely to recognize it and more willing to try it.
Average consumption amounts for the fruit and vegetable snacks ranged from 50 percent (baby carrots and grape tomatoes) to almost 100 percent (kiwis and red grapes). Average consumption amount for all snacks combined was 67 percent. In general, there was a positive association between consumption amount and willingness to try — such that, higher willingness resulted in greater consumption. While recognition did increase during the course of the study, it was not predictive of consumption.
Our study provides evidence that a school-based, fruit and vegetable snack-feeding program can increase children’s familiarity with, and potentially, the consumption amount of fruits and vegetables. While familiarity was not predictive of consumption, it is possible that an indirect effect was present given that greater familiarity was associated with higher willingness to try the fruits and vegetables.
Importantly, our results show that willingness to try fruits and vegetables were high in these children, and even those indicating they were unwilling to try a specific fruit or vegetable did eat at least a small portion of the food when it was offered. Hence efforts to introduce fruits and vegetables into school meal programs through education and repeated offerings may increase students’ demand for such healthy foods, both in the school and home environments.