Background

The vast majority of adolescents in the United States (U.S.) do not eat recommended amounts of fruits and vegetables (F&V)¹. A common barrier to F&V intake is not having F&V access within the home, as many families face physical, social, and economic barriers to healthy foods^2-4. Disparities in neighborhood access to healthy foods have been widely documented in the U.S.⁴

One objective of school lunch programs is to provide an alternative source of F&V to students who face such barriers. Studies have shown, however, that school meals often do not meet nutrition standards^5,6. As a result, many federal, state, and local policymakers in the U.S. have enacted laws to strengthen school meal standards, including requiring a minimum number of F&V^7,8. A study was conducted to determine if: 1) students consumed more F&V overall if they resided in states with laws that required F&V in school meals, and 2) determine if such laws were associated with smaller disparities in F&V intake between students who had access to healthy foods at home versus those who did not.

Data on FV consumption and state laws

This cross-sectional study linked data on students’ F&V consumption with state laws regarding F&V requirements for school meals. Student data came from the National Youth Physical Activity and Nutrition Study (NYPANS), a nationally representative study of 9th-12th grade students, conducted by the Centers for Disease Control and Prevention in Spring 20109. State law data were obtained from legal research databases as part of the Bridging the Gap research program.

Using a written questionnaire, students reported how many cups of F&V they eat or drink each day; fruits and vegetables were measured separately. Students also reported how often F&V were available at home, and how often unhealthy snacks (“chips, cookies, or cakes”) were available at home. Questions on food access included five response options, ranging from “never” to “always.” These data were linked to state laws governing F&V requirements for school meals in high schools. Only two states in NYPANS – California and Mississippi – required high schools to provide a minimum number of F&V in school meals during the 2009-10 school year.

Importance of the home food environment

As expected, students tended to consume more F&V if they had more access to F&V at home. Vegetable intake, for example, ranged from 0.41 cups/day among students who never had access to F&V at home (95% confi dence interval (CI): 0.28, 0.54) to 1.25 cups/day among students who always had access (95% CI: 1.19, 1.31). Conversely, the more often students had access to unhealthy snacks, the fewer F&V they tended to consume.

State laws associated with smaller disparities

In the total sample, there was little association between F&V requirement laws and F&V intake. Students in California/Mississippi consumed 0.03 fewer cups of fruit (95% CI: -0.09, 0.03) and 0.04 more cups of vegetables (95% CI: -0.02, 0.11) per day, on average, compared to states that did not require F&V in school meals. In contrast, however, laws were associated with higher F&V intake among students who did not have regular access to F&V at home, particularly if they obtained a school lunch 4-5 days/week. This subsample consumed 0.45 more cups of fruit (95% CI: 0.07, 0.84) and 0.61 more cups of vegetables (95% CI: 0.21, 1.00), on average, if they resided in California or Mississippi versus states with no fruit/vegetable requirements. Consequently, disparities in F&V intake were considerably smaller in California/Mississippi versus other states.

Implications

The home food environment is a consistent predictor of F&V intake among children¹⁰, but this study suggests that state laws that require F&V in school meals may benefi t students with limited F&V access at home. Results were similar in California and Mississippi, two states that have aggressively targeted school meal standards despite being dissimilar in many political, demographic, and cultural respects.

Our study was limited by its cross-sectional design, which makes it impossible to conclude that F&V laws caused higher intake. Yet our evidence is encouraging, particularly given that school lunch programs in the U.S. were originally designed to address disadvantages that lowincome children face. Previous research suggests that school meal programs have fallen short of that objective, but improvements to school meal standards have the potential to reduce disparities that are caused by disadvantages beyond school.