This study assessed the extent to which access to home gardens associate with the frequency of fruit and vegetable (FV) consumption.

The study was carried out in fifty rural communities in Northern Ghana where food insecurity and malnutrition including micronutrient deficiencies are prevalent.

A community-based comparative analytical cross-sectional study.

A sample of 847 randomly selected rural households.

The proportion of households that consumed FV at least 3 d in a week was 45 %. Members in households who owned a home garden were 1·5 times more likely to consume FV at least 3 d in a week (adjusted OR (AOR) = 1·46 (95 % CI 1·06–2·0)), compared with their counterparts who had no home gardens. Furthermore, households in which mothers had a positive attitude towards FV consumption were 1·6 times more likely to consume FV (AOR = 1·63 (95 % CI 1·17–2·27)) compared with mothers who were less positive.

Our results suggest that food and nutrition policy measures that promote home gardens can improve consumption of diversified diets including FV among vulnerable rural households in Northern Ghana. Additionally, households with lower income may benefit from nutrition behaviour change communication campaigns directed towards increasing a positive attitude to FV intake.

This study uses participatory modelling with stakeholders to assess the potential impacts of three interventions intended to increase fruit and vegetable (F&V) consumption in urban Kenya.

A participatory process using Group Model Building (GMB) developed a conceptual model of the determinants of vegetable consumption. A subsequent quantitative System Dynamics model using data from primary and secondary sources simulated vegetable consumption from 2020 to 2024 under three proposed interventions suggested by stakeholders: increasing consumer awareness, reducing post-harvest losses and increasing farm yields. Model analyses assumed mean parameter values and assessed uncertainty using 200 simulations with randomised parameter values.

The research was implemented in Nairobi, Kenya with simulation analyses of mean per capita consumption in this location.

Workshops convened diverse F&V value chain stakeholders (farmers, government officials, NGO staff and technical experts) to develop the conceptual model, data inputs and intervention scenarios.

Increasing consumer awareness was simulated to increase vegetable consumption by relatively modest amounts by 2024 (5 g/person/d from a base of 131 g/person/d) under mean assumed value of value chain response parameters. Reducing perishability was simulated to reduce consumption due to the higher costs required to reduce losses. Increasing farm yields was simulated to have the largest impact on consumption at assumed parameter values (about 40 g/person/d) but would have a negative impact on farm profits, which could undermine efforts to implement this intervention.

The combination of GMB and simulation modelling informed intervention priorities for an important public health nutrition issue.

This study pilot-tested combining financial incentives to purchase fruits and vegetables with nutrition education focused on cooking to increase the consumption of fruits and vegetables and improve attitudes around healthy eating on a budget among low-income adults. The goal of the pilot study was to examine implementation feasibility and fidelity, acceptability of the intervention components by participants and effectiveness.

The study design was a pre-post individual-level comparison without a control group. The pilot intervention included two components, a scan card providing free produce up to a weekly maximum dollar amount for use over a 2-month period, and two sessions of tailored nutrition and cooking education. Outcomes included self-reported attitudes about healthy eating and daily fruit and vegetable consumption from one 24-h dietary recall collected before and after the intervention.

Greater Minneapolis/St. Paul area in Minnesota.

Adults (n 120) were recruited from five community food pantries.

Findings indicated that the financial incentive component of the intervention was highly feasible and acceptable to participants, but attendance at the nutrition education sessions was moderate. Participants had a statistically significant increase in the consumption of fruit, from an average of 1·00 cup/d to 1·78 cups/d (P < 0·001), but no significant change in vegetable consumption or attitudes with respect to their ability to put together a healthy meal.

While combining financial incentives with nutrition education appears to be acceptable to low-income adult participants, barriers to attend nutrition education sessions need to be addressed in future research.

A social network is a valuable resource in later life. Therefore, the current study aims to investigate whether social networks within homes and neighbourhoods are associated with older adults’ daily fruit and vegetable consumption.

Cross-sectional secondary data analysis.

USA.

A nationally representative sample of 6865 community-dwelling older adults over age 53 in the Health and Retirement Study – Health Care and Nutrition Survey.

Older adults who lived alone with no children or friends nearby had the lowest fruit and vegetable consumption. However, the daily fruit and vegetable consumption of respondents who lived alone and had children or friends nearby or those who lived with someone and had no children or friends nearby was not statistically different from those who lived with someone and had children or friends nearby. This suggests that having a social network either at home or in the neighbourhood complements the absence of living with someone or having children or friends nearby and attenuates the negative association between limited social networks and daily fruit and vegetable consumption. A greater decrease in the number of fruits and vegetables consumed was observed among men when they lived alone with no children or friends nearby.

Special attention should be given to older adults with limited social networks, especially older adults living alone with no children or friends nearby. Provision of help with grocery shopping and meal preparation as well as social support networks and more opportunities that can improve social engagement appear to be necessary.

To evaluate the relationship between fruits and vegetables (F&V) availability at home and young people’s F&V consumption behaviour, and how the theory of planned behaviour (TPB) constructs could potentially mediate the relationship.

Cross-sectional face-to-face survey questionnaire to assess the TPB constructs and home food availability assessed using open inventories method. F&V availability was categorised into low and high levels based on median split.

Singapore.

Two hundred and ten households (each consisting one parent–child pair) recruited via stratified cluster sampling with child participants ranging from 9 to 16 years of age.

Mediation analyses were conducted using structural equation modelling. The relationship between home F&V availability and F&V consumption behaviour did not have a significant direct association, but there were significant indirect effects through the routes of perceived behavioural control (PBC) and intention as well as attitude and intention. Specifically, higher level of F&V availability at home was related to more positive PBC and attitude towards F&V, and subsequently greater intention to consume F&V and higher consumption of F&V.

Parents should make F&V more readily available at home as increased exposure to F&V could be related to enhanced liking, sense of control and intention to consume F&V and facilitate children’s healthy diet.

To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.

Cross-sectional telephone surveys using a validated 24 h dietary assessment.

Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.

Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.

Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.

The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

The present study aimed to examine the correlates of fruit and vegetable intake (FVI) separately among parents and their adolescents.

Cross-sectional surveys.

Online survey.

Parents and adolescents completed the Family Life, Activity, Sun, Health, and Eating (FLASHE) survey through the National Cancer Institute. The survey assessed daily intake frequencies of food/beverage groups, psychosocial, parenting and sociodemographic factors. Generalized linear models were run for both parents and adolescents, for a total of six models (three each): (i) sociodemographic characteristics; (ii) psychosocial factors; (iii) parent/caregiver factors.

Parent participants (n 1542) were predominantly 35–59 years old (86 %), female (73 %), non-Hispanic White (71 %) or non-Hispanic Black (17 %), with household income <$US 100 000 (79 %). Adolescents (n 805) were aged 12–14 years (50 %), non-Hispanic White (66 %) and non-Hispanic Black (15 %). Parents consumed 2·9 cups fruits and vegetables (F&V) daily, while adolescents consumed 2·2 cups daily. Educational attainment (higher education had greater FVI) and sex (men consumed more than women; all P<0·001) were significant FVI predictors. Parents with greater autonomous and controlled motivation, self-efficacy and preferences for fruit reported higher FVI (all P<0·001). Similarly, adolescents with greater autonomous and controlled motivation, self-efficacy and knowledge reported higher FVI (all P<0·001). Parenting factors of importance were co-deciding how many F&V teens should have, rules, having F&V in the home and cooking meals from scratch (all P<0·05).

Findings suggest factors that impact FVI among parents and their adolescent(s), which highlight the importance of the role of parent behaviour and can inform tailored approaches for increasing FVI in various settings.

To investigate the potential dietary impact of the opening of new retailers of healthy foods.

Systematic review of the peer-reviewed research literature.

References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches.

The outcome of the review was change in fruit and vegetable consumption among adults.

Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers’ market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23–0·54 servings/d) at 6–12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent.

The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear.

To explain patterns of fruit and vegetable consumption in nine former Soviet Union countries by exploring the influence of a range of individual- and community-level determinants.

Cross-sectional nationally representative surveys and area profiles were undertaken in 2010 in nine countries of the former Soviet Union as part of the Health in Times of Transition (HITT) study. Individual- and area-level determinants were analysed, taking into account potential confounding at the individual and area level.

Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine.

Adult survey respondents (n 17 998) aged 18–95 years.

Being male, increasing age, lack of education and lack of financial resources were associated with lower probability of consuming adequate amounts of fruit or vegetables. Daily fruit or vegetable consumption was positively correlated with the number of shops selling fruit and vegetables (for women) and with the number of convenience stores (for men). Billboard advertising of snacks and sweet drinks was negatively related to daily fruit or vegetable consumption, although the reverse was true for billboards advertising soft drinks. Men living near a fast-food outlet had a lower probability of fruit or vegetable consumption, while the opposite was true for the number of local food restaurants.

Overall fruit and vegetable consumption in the former Soviet Union is inadequate, particularly among lower socio-economic groups. Both individual- and community-level factors play a role in explaining inadequate nutrition and thus provide potential entry points for policy interventions, while the nuanced influence of community factors informs the agenda for future research.

Performing and publishing mediator analyses, whether significant or null, provides insight into where research efforts should focus and will assist in developing effective and powerful behaviour change interventions. The present study examined whether self-efficacy, social support and church support mediated changes in leisure-time physical activity (PA) and fruit and vegetable (F&V) consumption in a faith-based intervention.

A 15-month PA and F&V intervention, guided by the structural ecological model, targeted the social, cultural and policy influences within the church. Outcomes and mediators were measured at baseline and follow-up. Data were collected from 2007 to 2011. MacKinnon’s product of coefficients tested for mediation.

Sixty-eight African Methodist Episcopal churches in South Carolina, USA.

Five hundred and eighty-two (PA) and 588 (F&V) church members.

Despite the significant increases in PA and F&V consumption, none of the hypothesized mediators were significant mediators of change in PA or F&V consumption. When examining each path of the mediation model, the intervention did not change any of the hypothesized mediators. However, changes in some mediators were associated with changes in outcomes.

Although there was no significant mediation, the association between changes in mediators and changes in PA and/or F&V consumption suggest that these variables likely play some role in changing these behaviours. Future studies should consider mediation analyses a priori, putting careful thought into the types of measures used and the timing of those measures, while also being cognizant of participant and staff burden. Finding a balance will be fundamental in successfully understanding how interventions exert their effects.

To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.

Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.

Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries.

A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.

The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8–37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).

Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.

In 2009, the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began to provide participants with cash-value vouchers to purchase fruits and vegetables ($US 10 for women and $US 6 for children per month). The present paper assesses the potential effects of the new WIC incentives on fruit and vegetable purchases among WIC households in two New England states.

A pre–post assessment of changes in fruit and vegetable purchases after the WIC revisions in generalized estimating equation models.

Scanner data on grocery purchases from a regional supermarket chain in New England, USA.

WIC-participating households (n 2137) that regularly shopped at the chain during January–September 2009 and January–September 2010.

After the WIC revisions, purchases of fresh and frozen vegetables increased in volume by 17·5 % and 27·8 %, respectively. The biggest improvements were observed for fresh fruit, an increase of 28·6 %, adding almost a kilogram of fresh fruits per household per month. WIC households spent three times more of their WIC vouchers on purchasing fresh fruits than fresh vegetables. The magnitudes of substitution effects were relatively small: between 4 % (fresh fruit) and 13 % (canned vegetables) of the amounts purchased in 2009 with non-WIC funds were replaced by purchases made using WIC vouchers in 2010.

The provision of fruit and vegetable benefits in the revised WIC food packages increased overall purchases of fruits and vegetables among WIC-participating households in New England. Efforts to encourage consumption of fruits and vegetables by people receiving federal food assistance are paying off.

We examined associations between access to food venues (farmers’ markets and supermarkets), shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, USA.

Access to food venues was measured using a Geographic Information System incorporating distance, seasonality and business hours, to quantify access to farmers’ markets. Produce consumption was assessed by self-report of eating five or more fruits and vegetables daily. BMI and blood pressure were assessed by clinical measurements. Poisson regression with robust variance was used for dichotomous outcomes and multiple linear regression was used for continuous outcomes. As the study occurred in a university town and university students are likely to have different shopping patterns from non-students, we stratified analyses by student status.

Eastern North Carolina.

Low-income women of reproductive age (18–44 years) with valid address information accessing family planning services at a local health department (n 400).

Over a quarter reported ever shopping at farmers’ markets (114/400). A larger percentage of women who shopped at farmers’ markets consumed five or more fruits and vegetables daily (42·1 %) than those who did not (24·0 %; P < 0·001). The mean objectively measured distance to the farmers’ markets where women reported shopping was 11·4 (sd 9·0) km (7·1 (sd 5·6) miles), while the mean distance to the farmers’ market closest to the residence was 4·0 (sd 3·7) km (2·5 (sd 2·3) miles).

Among non-students, those who shopped at farmers’ markets were more likely to consume five or more servings of fruits and vegetables daily. Future research should further explore potential health benefits of farmers’ markets.

Recommendations for fruit and vegetable consumption are largely unmet. Lower socio-economic status (SES), neighbourhood poverty and poor access to retail outlets selling healthy foods are thought to predict lower consumption. The objective of the present study was to assess the interrelationships between these risk factors as predictors of fruit and vegetable consumption.

Cross-sectional multilevel analyses of data on fruit and vegetable consumption, socio-demographic characteristics, neighbourhood poverty and access to healthy retail food outlets.

Survey data from the 2002 and 2004 New York City Community Health Survey, linked by residential zip code to neighbourhood data.

Adult survey respondents (n 15 634).

Overall 9·9 % of respondents reported eating ≥5 servings of fruits or vegetables in the day prior to the survey. The odds of eating ≥5 servings increased with higher income among women and with higher educational attainment among men and women. Compared with women having less than a high-school education, the OR was 1·12 (95 % CI 0·82, 1·55) for high-school graduates, 1·95 (95 % CI 1·43, 2·66) for those with some college education and 2·13 (95 % CI 1·56, 2·91) for college graduates. The association between education and fruit and vegetable consumption was significantly stronger for women living in lower- v. higher-poverty zip codes (P for interaction < 0·05). The density of healthy food outlets did not predict consumption of fruits or vegetables.

Higher SES is associated with higher consumption of produce, an association that, in women, is stronger for those residing in lower-poverty neighbourhoods.

Few studies have investigated the association between adolescents’ socio-economic status (SES) and health behaviours in developing countries. Socio-economic differences in breakfast eating, fruit and vegetable consumption and physical activity were investigated among Ghanaian adolescents.

A school-based survey of 12–18-year-olds (n 1195, response rate 89·7 %) was conducted in 2008. Logistic regression analyses were applied to study the associations between breakfast eating, fruit and vegetable consumption and physical activity, and SES.

Southern Ghana, West Africa.

School pupils aged 12–18 years.

Of all adolescents, 31 % took breakfast less than 4 d/week, over half (56 %) and 48 %, respectively, rarely ate fruits and vegetables. Younger adolescents (12–15-year-olds) consumed fruits and vegetables frequently compared with older ones (16–18-year-olds). Boys were more likely to participate in physical activity than girls. The probability of frequent breakfast eating was higher in adolescents from more affluent backgrounds than in those from less affluent ones. Compared with those whose mothers were illiterate, both tertiary and primary maternal educational attainment increased the probability of frequent fruit intake. Similarly, tertiary educational attainment increased the likelihood of frequent vegetable intake. Compared with those with unemployed mothers, mothers’ low employment grade was related to higher probability of frequent fruit intake. High school performance was associated with frequent fruit intake, whereas high or medium school performance increased the likelihood of vegetable intake compared with low school performance.

Interventions are needed to improve breakfast intake, fruit and vegetable consumption and physical activity in order to prevent degenerative diseases among Ghanaian adolescents.

To evaluate the feasibility and effectiveness of a pilot family-based newsletter intervention to increase fruit and vegetable (FV) consumption among adolescents.

Family-based, two-group randomised control trial with baseline, post-intervention and follow-up measures. The intervention group received two FV newsletter packs over a 1 month period by postal mail. Social cognitive and behavioural choice theories provide the theoretical framework for the design and development of intervention materials. Control families were provided with all intervention materials at the end of the study. Adolescent FV consumption was assessed by an FFQ. Adolescent-reported barriers to eating FV, FV habits and preferences were the secondary outcomes, along with parent FV consumption, and parents reported knowledge, encouragement, home availability and accessibility of FV. Repeated-measures ANOVA was used to detect differences in behavioural and psychosocial outcomes between groups, time and group-by-time.

East Midlands, UK.

Forty-nine parents and adolescents aged 12–14 years.

Process evaluation indicated high reach, dose acceptability and fidelity of the intervention. At post-intervention and 6 weeks later at follow-up, adolescents in the intervention group had significantly higher fruit: (P < 0·01) and vegetable (P < 0·05) consumption and higher preferences for vegetables (P < 0·01), compared with the control group. At post-intervention and follow-up, parents in the intervention group had significantly higher fruit (P < 0·001) and vegetable (P < 0·01) consumption and reported higher accessibility of fruit and vegetables (P < 0·001), compared with those in the control group.

Family-based, newsletter interventions promoting FV consumption to adolescents appear to be feasible and effective at increasing FV consumption.

The objective of the present study was to examine associations between exposure to nutrition information as covered in mass media and daily fruit and vegetable (FV) consumption among adolescents.

Cross-sectional nutrition survey.

Vocational schools in Vienna, Austria.

A sample of 2949 ethnically diverse adolescents with mean age 17·3 (sd 1·7) years. An FFQ was used to assess usual FV consumption. Data on mass media exposure and sociodemographic characteristics were collected by means of a self-administered questionnaire. Multiple logistic regression analyses were used to control for potentially confounding variables.

Adolescents who reported exposure to nutrition information provided by booklets, the Internet or newspaper articles were more likely to eat FV daily. For example, the OR for daily fruit consumption (ORfru) was 1·6 (P < 0·001) when exposure to the Internet was reported after adjustment for age, gender, ethnicity, BMI and salary. No such associations were found for radio, television and magazines as sources of nutrition information. A negative impact on daily FV consumption was found for exposure to radio commercials (ORfru = 0·74, P = 0·04 and ORveg = 0·67, P = 0·03). Exposure to TV commercials had a negative impact on vegetable consumption (ORveg = 0·81, P = 0·05).

Newspaper articles, the Internet and booklets as a source of nutrition information are positively associated with daily FV consumption among adolescents, whereas radio commercials have a negative impact. Dissemination of ‘healthy eating’ slogans should make use of print media and the Internet.