Increasing Child Fruit and Vegetable Intake: Findings from the US Department of Agriculture Fresh Fruit and Vegetable Program.

BACKGROUND
Fewer than 10% of US children and adolescents consume the recommended amounts of fruits and vegetables (F/V). The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) is intended to increase child F/V consumption by funding low-income schools to distribute free fresh F/V snacks outside of school mealtimes.

OBJECTIVE
The evaluation assessed FFVP effects on student F/V consumption and total energy intake in and out of school.

DESIGN
The evaluation employed a regression discontinuity design; that is, cross-sectional comparisons of a sample of students in schools just above and just below the FFVP funding cutoff for the program, which depended on the proportion of students eligible for free or reduced-price meals. During the 2010-2011 school year within a randomly selected sample of states, we selected schools in closest proximity to each state-specific FFVP funding cutoff. Interviewers conducted 24-hour diary-assisted recall interviews to assess dietary intake among children in selected schools.

PARTICIPANTS/SETTING
Participants were 4,696 students (grades 4 to 6) from 214 elementary schools in 16 randomly selected states.

STATISTICAL ANALYSES PERFORMED
Analysis proceeded via multivariate regression, comparing adjusted mean student intake in schools just above and just below the funding cutoff.

RESULTS
Adjusted mean daily F/V intake was one-third of a cup per day higher in FFVP-participating schools than in nonparticipating schools (0.32 cups per day; P<0.001), a difference of 15.5%. This included one-quarter cup higher daily F/V intake during school hours (0.26 cups; P<0.001) among students attending FFVP-participating schools. Fresh (but not total) F/V consumption also increased outside of school.

CONCLUSIONS
The FFVP increases child fresh and total F/V intake in school, and fresh F/V intake outside of school.