Fruits, Vegetables, and Health: A Scientific Overview, 2011
Fruit and vegetable intake in American adults remains well below recommended levels, despite evidence of the health benefits of diets high in fruits and vegetables. Efforts to increase fruit and vegetable intake include behavioral-based interventions. Generally, these interventions have demonstrated small increases in intake during the duration of the study, although the behavioral approaches providing the greatest increase in intake have not been clearly established. Several common behavioral theories and approaches have been employed to promote change in health behavior, including greater fruit and vegetable intake (Table 1). Interventions that apply behavior theory are delivered, using a variety of delivery settings (schools, churches, community centers, healthcare organizations, etc.), as well as with a diversity of approaches including face-toface counseling, telephone-based delivery, printed materials (including tailored and nontailored documents), and more recently, computer-based, technology-driven strategies for delivery of interventions targeting behavioral change.
Review of intake and behavioral approaches
A systematic review of MEDLINE PubMed and PsycINFO databases was conducted to identify all reported human intervention trials related to fruit and vegetable intake and behavioral approaches since 1995. Using predetermined limits and selection criteria, 65 manuscripts were identified, providing 57 study samples for inclusion in this systematic review. The purpose of this systematic review is to provide a description of selected literature reporting the effect of behaviorbased interventions on fruit and vegetable consumption, including special subgroups within the population such as children and minorities. Although the initial intent was to identify “best practices” in relation to behavioral approaches/theories applied and reported change in fruit and/or vegetable intake, the lack of consistency and detail in reported study design made this aim unachievable at this time.
Statistically significant change achieved
The most frequently applied behavioral approach was Stages of Change. Current evidence suggests that statistically significant change in fruit and vegetable intake is achieved with behavior-based interventions, as currently designed and delivered. Behavioral interventions in adult population samples resulted in increased fruit and vegetable intake averaging 1.06 servings/day; in older-adult intervention studies, the same mean change in intake was suggested. Interventions involving minority adults demonstrated a mean increase in daily fruit and vegetable consumption of 0.9 servings. In studies of low-income groups, only three of the five studies provided daily serving data, and the average increase in fruit and vegetable intake was 0.15 servings/day. Behavioral interventions in children have demonstrated an average increase in intake of 0.65 servings/day. Worksite interventions generally demonstrated less of an increase in mean daily fruit and vegetable intake, with a 0.54 increase in servings/day across 12 studies. There is limited evaluation of or current evidence for sustained change in fruit and vegetable intake with behavioral interventions. No studies have compared two or more specific behavioral theories with regard to differences in change estimates for fruit and vegetable intake.
Integration of strategies required
New and novel approaches are needed to more extensively evaluate behavior-based theories in relation to promoting significant increases in fruit and vegetable consumption in Americans. Efforts to integrate behaviorbased strategies with social marketing, social networking, and/or technology-based behavioral control should be more extensively pursued in order to increase fruit/vegetable intake in the population, beyond what is achieved with current, behavioral-based interventions alone. Finally, achieving and sustaining fruit and vegetable intake at currently recommended levels across the population will require stronger interventions, coupled with other approaches including efforts to address taste, convenience, availability and access, competitive foods, and value perceptions.
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