1. University of Wisconsin-Eau Claire Evaluating the USDA Fresh Fruit & Vegetable Program Using Incentives and Reminders to Increase Fruit and Vegetable Intake Among Wisconsin Elementary School Students Evaluating the USDA Fresh Fruit & Vegetable Program Using Incentives and Reminders to Increase Fruit and Vegetable Intake Among Wisconsin Elementary School Students Amber Jamelske, Bryan Reinhold, Kevin Reinhold and Elizabeth Reinke Faculty Mentors: Dr. Lori Bica and Dr. Eric Jamelske University of Wisconsin-Eau Claire Economics & Psychology Departments Chippewa Valley Center for Economic Research & Development

2. University of Wisconsin-Eau Claire Overview  Introduction  USDA Fresh Fruit & Vegetable Program  2008-09 Evaluation –Morning Snack –F&V Coupons  2009-10 Evaluation –Daily Snack Track –Incentives & Reminders  Questions and Discussion

3. University of Wisconsin-Eau Claire Introduction  Overweight and obesity among children.  Inadequate fruit and vegetable consumption (not 5-9 a day).  USDA Fresh Fruit and Vegetable Program (FFVP) was created to improve nutrition and help combat childhood obesity (2002).

4. University of Wisconsin-Eau Claire  The FFVP provides funding for students from selected schools to receive a free fruit or vegetable (FV) snack 3-4 days a week for an academic year.  Wisconsin first received FFVP funding in 2006 and the FFVP was expanded to all 50 states plus the District of Columbia, Guam, Puerto Rico and Virgin Islands through the 2008 US Farm Bill.  USDA –http://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htmhttp://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htm  Wisconsin Department of Public Instruction –http://dpi.wi.gov/fns/ffvp.htmlhttp://dpi.wi.gov/fns/ffvp.html The Fresh Fruit & Vegetable Program

7. University of Wisconsin-Eau Claire  4 Western Wisconsin Elementary Schools –2 program and 2 matched control –4 th and 5 th grade students  Survey questions –How many FV do students eat? –Day In The Life Questionnaire (DILQ) –Average daily F/V intake (measured over 3 days) 2008-09 Evaluation Process

8. University of Wisconsin-Eau Claire Full Sample Demographics N = 347

9. University of Wisconsin-Eau Claire 2008-09 Evaluation Process  Pre-test survey – September 2008  Program began – October 2008  Morning snack in classroom (3 or 4 days a week)  Post-test I survey – December 2008  Post-test II survey – April 2009  Pre-test – Post-test II change in FV intake –DILQ, average daily F/V intake (measured over 3 days)

12. Baseline Fruit & Vegetable Intake

14.  Average FV intake generally low.  Students do not eat FV for Morning snack.  Most FV consumption during lunch.  Differences in FV intake attributable to FV offered on lunch menu.

15. FV Offerings at School Lunch

16. University of Wisconsin-Eau Claire Fruit & Vegetable Snacks & Surveys  Free FV snack in the classroom for morning snack  Surveys conducted on Tuesday, Wednesday and Thursday  FV intake recall from Monday, Tuesday and Wednesday  School 1: Four days per week  School 2: Three days per week

17.  School 1: cauliflower (50%), papaya (51%), pineapple (81%) –Fruit: 2 out of 3 days (2/3) Vegetable: 1 out of 3 days (1/3)  School 2: none, papaya (18%), orange (80%) –Fruit: 2 out of 3 days (1/3) Vegetable: 1 out of 3 days (1/3) Change in FV Intake at Morning Snack

18. University of Wisconsin-Eau Claire Fruit & Vegetable Snacks & Surveys  Free FV snack in the classroom for morning snack  Surveys conducted on Tuesday, Wednesday and Thursday  FV intake recall from Monday, Tuesday and Wednesday  School 1: Four days per week  School 2: Three days per week

19.  School 1: watermelon (92%), cucumber (73%), apple (81%) –Fruit: 2 out of 3 days (2/3) Vegetable: 1 out of 3 days (1/3)  School 2: none, grapes (84%), carrots (62%) –Fruit: 1 out of 3 days (1/3) Vegetable: 1 out of 3 days (1/3) Change in FV Intake at Morning Snack

20. Morning Snack Comparison  Free F/V morning snack (Tuesday survey, Monday recall) –School 1: watermelon (92%) –School 2: none

21. What FV Snacks Were Provided?

22. University of Wisconsin-Eau Claire Conclusion  The FFVP Works!  Meaningful ↑ FV intake for intervention students by providing free access during the morning snack period (compared to control group).  Program effect is limited.  No evidence of ↑ FV intake without free access. –Breakfast, after-school snack, dinner, night-time snack, non-FFVP days If students are provided with free FV with no alternatives THEY WILL EAT THEM!

23. University of Wisconsin-Eau Claire Free and Discount Coupons  34 families of students from the two intervention schools were given 5 free coupons each redeemable for $2 free FV (valid one week).  Same families also given 3 discount coupons each redeemable for $2 off a $5 FV purchase (valid the following week).  Coupon redemption rates.  DILQ given 3 days during week that free coupons were valid.  Did students that redeemed free coupons show increased FV intake compared to control group from same schools?

24. Free and Discount Coupons  Nearly every family took advantage of the free coupons which required nothing more than a trip to the grocery store to buy the FV.  27 families redeemed at least 4 free coupons.  Most families did not make use of the discount coupons which would have required them to spend some of their own money in addition to going to the grocery store.

25. University of Wisconsin-Eau Claire Conclusion  Small, but significant increase in FV intake among free coupon students compared to control students.  Limited to FRUIT: breakfast, dinner and night-time snack.  Increases occurred when parents were likely home.  Schools cannot afford to use free FV coupons to expand the reach of the FFVP into the home.  This research could be applied to other USDA programs considering FV: WIC and Food Stamps.

27. University of Wisconsin-Eau Claire 2009-10 Research Evaluation  Four New Western Wisconsin elementary schools  One intensive intervention*  Daily FV snack tracking*  Incentives and reminders*

28. University of Wisconsin-Eau Claire Intensive Intervention  4 th and 5 th grade classrooms (4)  Free FV snacks served three days a week for afternoon snack.  Do students bring FV snacks from home on non-FFVP snack days?  Do incentives and reminders help?

29. F&V Snack Track – Binder - Wall Chart  Wednesday & Friday: Teacher writes FV snack brought from home.

30. University of Wisconsin-Eau Claire FFVP Snack Days  October 2009 – March 2010.  Do students eat FV snacks FFVP snack days?  Celery, Jicama, Pear, Kiwi served multiple times.  Four classrooms.

31. Free FFVP Snacks

34. University of Wisconsin-Eau Claire Non-FFVP Snack Days  Five periods of study between October 2009 – March 2010.  Do students bring FV snacks from home on non-FFVP snack days?  Do incentives and reminders help?  Three teachers.

35. University of Wisconsin-Eau Claire Non-FFVP Snack Days  Period 1: No incentives.  Period 2: Sticker wall chart.  Period 3: Sticker wall chart and toy prizes. –Holiday Break  Period 4: No incentives  Period 5: Mixed incentives and reminders

36. University of Wisconsin-Eau Claire Period 5  Teacher 2: Stop everything (only track in binder). –She was doing HW reminders and positive modeling and praise  Teachers 1 & 4: HW reminders, positive modeling, praise and toy prizes.  Teacher 3: HW reminders, positive modeling, praise, but no toy prizes.

39. University of Wisconsin-Eau Claire Conclusion  Using toy prizes as incentives can influence students to bring FV items from home to eat as a snack at school when they otherwise would not have done so.  Most successful when teacher uses HW reminders and engages students with positive modeling and praise.

40. University of Wisconsin-Eau Claire Conclusion  This research is compelling because it provides a framework for schools to expand the reach of the FFVP beyond the access to free FV provided as snacks in the classroom.  Perhaps the most important aspect of the incentive scheme presented in this study is that it is both feasible and affordable in terms of time, resources and money….  And it seems to work effectively!  Come see our two posters in the Riverview Ballroom**

41. University of Wisconsin-Eau Claire

44. Eric Jamelske & Lori Bica jamelsem@uwec.edu, bicala@uwec.edu jamelsem@uwec.edubicala@uwec.edu Questions?