1. University of Wisconsin-Eau Claire Getting Children To Eat More Fruits & Vegetables: What Works? Students: Tyler Christiansen, Judy Dickinson, Stephen Fisher, Lainee Hoffman, Stephanie Mabrey, Kevin Reinhold, April Ross, and Laurelyn Wieseman Faculty Mentors: Dr. Eric Jamelske and Dr. Lori Bica University of Wisconsin-Eau Claire Economics & Psychology Departments Chippewa Valley Center for Economic Research & Development

2. University of Wisconsin-Eau Claire Overview  Motivation  FFVP Background  Initial Impact on FV Intake  Impact on attitudes/behavioral intent and intake  Explore repeated FV exposure  Expanding the Reach of the FFVP  Questions and Discussion

3. Introduction  Inadequate FV consumption (not 5-9 a day)  Lots of less healthy alternatives  Rising rates of childhood and adult obesity  Significant health care concern, annual costs in the BILLIONS of $

4. Introduction  Use school setting to address this very important issue  USDA created Fresh Fruit and Vegetable Snack Program (FFVP) to improve nutrition and combat obesity (2002)

5. University of Wisconsin-Eau Claire  Provides funding for students in selected schools to receive a free FV snack 3-4 days a week through the year.  Elementary schools with at least 50% free/reduced population  Budget guidelines allow spending of $50-75 per student per year  Up to 10% of funds can be used for labor/capital expenses  Schools choose how many days/week, when/where to serve FV snacks, and how much, if any, nutrition education to include. The Fresh Fruit & Vegetable Program

6.  USDA  http://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htm http://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htm  Wisconsin Department of Public Instruction  http://dpi.wi.gov/fns/ffvp.html http://dpi.wi.gov/fns/ffvp.html

7. University of Wisconsin-Eau Claire  Wisconsin 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.  Expanding the FFVP nationwide involved significant cost, as funding increased from $18.9 million for 2007-08 to $50 million for 2008-09.  Given the sizeable resources committed to the FFVP, it is important to ascertain the degree to which it has achieved the stated purpose and goals. The Fresh Fruit & Vegetable Program

8. University of Wisconsin-Eau Claire  4 Western Wisconsin elementary schools –2 program (n = 124) –free FV morning snack three or four days/week –2 matched control (n = 134), no free FV snack –4 th and 5 th grade students –pre-test/post-test/post-test experimental design  Do students eat the fruit and vegetable snacks? –What did you eat yesterday at school for morning snack? 2008-09 Evaluation Process

9. University of Wisconsin-Eau Claire Conclusion  The FFVP Works!  All else equal, the FFVP ↑ average FV intake among program students by about 1/2 serving (compared to control)  Program effect is limited to free access at morning snack  Students did not bring FV from home to eat on non-FFVP days If students are provided with free FV with no alternatives THEY EAT THEM!

10. University of Wisconsin-Eau Claire 2009-10 Research, Part I  Two Western Wisconsin elementary schools  One program school (n = 76) –Free afternoon FV snack three days/week  One matched control school (n = 110) –No free FV snacks  Pre-test/Post-test experimental design (three survey days each)  Does FFVP increase FV intake for school snack?  Examine student attitudes and behavioral intent toward FV

11.  Measure average daily FV snack consumption (3 survey days)  Morning and afternoon snack  Test difference between program and control students  Sample restricted to students who were present on all three survey days for both pre-test and post-test (n = 51, 78)

12. University of Wisconsin-Eau Claire  The average over three days averaged across all students

13. University of Wisconsin-Eau Claire  The average over three days averaged across all students

15. University of Wisconsin-Eau Claire  Free afternoon snack on 2 days, early release on day 3  Apple (92%), Kiwi (84%)

16. University of Wisconsin-Eau Claire  Never = 1 Sometimes = 2 Often = 3 Always = 4

17. University of Wisconsin-Eau Claire  Never = 1 Sometimes = 2 Often = 3 Always = 4

18. 1234

19. 1234

20. 1234

21. University of Wisconsin-Eau Claire  Never = 1 Sometimes = 2 Often = 3 Always = 4

22. University of Wisconsin-Eau Claire  Never = 1 Sometimes = 2 Often = 3 Always = 4

23. 1234

24. 1234

25. 1234

26. University of Wisconsin-Eau Claire  Never = 1 Sometimes = 2 Often = 3 Always = 4

28. University of Wisconsin-Eau Claire  Never = 1 Sometimes = 2 Often = 3 Always = 4

29. 1234

30. 1234

31. University of Wisconsin-Eau Claire The FFVP Works!  Compared to control students…  Program students increased FV intake for school snack  Program students reported increased willingness to try new FV at home and especially at school  Program students reported asking their parents to buy FV more often when they went shopping  FFVP did not influence willingness to choose FV for snack over chips, cookies or candy

33. University of Wisconsin-Eau Claire 2009-10 Research, Part II  One Western Wisconsin elementary school (n = 76)  Daily afternoon snack behavior tracked by teacher  Do students eat the free FV snacks?  Explore repeated exposure to FV items

34. University of Wisconsin-Eau Claire Daily F&V Snack Track  Monday, Tuesday and Thursday are free FV snack days

36. University of Wisconsin-Eau Claire  Total FV eaten by students on free snack days, divided by the number of student days over the period (omit absences)  Ate none = 0 Tried = 0.25 Ate half = 0.5 Ate all =1

42. 0.797 0.757 0.854

43. 0.592 0.636 0.665 0.553 0.654

44. 0.620 0.618 0.685 0.864 0.660 0.637 0.709

45. 0.870 0.938 0.858 0.7760.782

46. 0.604 0.740 0.683 0.630

47. 0.654 0.640 0.750 0.576

48. 0.6010.5400.557

49. University of Wisconsin-Eau Claire The FFVP…..  Program served more than twice as much fruit (66) as vegetables (29)  Program relied on available supply of fresh local apples (34)  Reasonable variety of F (8) V (10)  Apples and Oranges, Kiwi and Pear...Blueberries and Watermelon  Carrots, Celery and Cucumber…Pea Pods, Green Pepper and Jicama

50. University of Wisconsin-Eau Claire WORKS!  Students generally eat the free FV snacks  Students prefer fruit to vegetables  They didn’t grow tired of apples and apples and apples…  An apple a day, keeps the doctor away!  Some evidence of developed FV preferences (likes/dislikes)  Tomatoes, Pea Pods, Green Peppers, Grapes, Pear

52. University of Wisconsin-Eau Claire 2009-10 Research, Part III  One Western Wisconsin elementary school (n = 76)  Daily afternoon snack behavior tracked by teacher  Days when no free FV snack was provided  Do students bring FV snacks from home on non-FFVP days?  Various phases of incentives, reminders, modeling and praise

53. University of Wisconsin-Eau Claire Daily F&V Snack Track  Wednesday and Friday are NOT free FV snack days

54. Non-Free Snack Days  Six distinct phases of study (October 2009 – May 2010)  Nothing  Wall chart with stickers  Small prizes  Positive role modeling/praise  Homework reminders  Phase One: 6 days  Phase Two: 6 days  Phase Three: 4 days  Phase Four: 4 days  Phase Five: 19 days  Phase Six: 14 days  53 total days

55. University of Wisconsin-Eau Claire  FV brought from home by students on non-free snack days, divided by the number of student days over the period (omits absences)  Ate all or at least half = 1

56. University of Wisconsin-Eau Claire  Ate all or at least half = 1

57.  Phase One: Baseline, no incentives  Phase Two: Stickers and wall charts

58.  Phase Three: Stickers, wall charts and toy prizes  Phase Four: Back to baseline, no incentives (after winter break)

59.  Phase Five: Toy prizes, modeling, praise and reminders, nothing  Phase Six: Toy prizes, modeling, praise and reminders

60. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders, Modeling/Praise & Toys

61. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders & Modeling/Praise Reminders, Modeling/Praise & Toys

62. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders, Modeling/Praise & Toys

63. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders, Modeling/Praise & Toys

64. The FFVP Works!  Toy PRIZES MATTER!  Homework reminders WORK!  Most successful when combined with POSITIVE MODELING & PRAISE!  A caring and dedicated teacher was able to get 70% of her students to bring FV snacks from home on a regular basis.

65. University of Wisconsin-Eau Claire The FFVP Works!  Framework for schools to expand the reach of the FFVP beyond the access to free FV provided as snacks in the classroom.  Feasible and affordable in terms of time, resources and money…. SCHOOLS CAN DO THIS!  It seems to work EFFECTIVELY!

66. FV Brought from Home in AWESOME Class

67. The FFVP WORKS! Cost is $50 per student plus toy Prizes and Praise Benefit is Priceless >

69. Questions?