Fruit and Vegetable Consumption Among High School Students — United States, 2010

Fruit and Vegetable Consumption Among High School Students — United States, 2010Weekly
November 25, 2011 / 60(46);1583-1586

A diet high in fruits and vegetables is associated with a decreased risk for many chronic diseases and some cancers (1), and can aid in weight management (2). Current daily fruit and vegetable recommendations for adolescents who participate in <30 minutes of physical activity daily are 1.5 cups of fruit and 2.5 cups of vegetables for females and 2 cups of fruit and 3 cups of vegetables for males (1) (1 cup is approximately equal to one medium apple, eight strawberries, 12 baby carrots, or one large tomato).* However, recently published data from the National Health and Nutrition Examination Survey 2003--2004 revealed that consumption was considerably below these levels (3). To assess fruit and vegetable consumption among high school students, CDC analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS). This report describes the results of that analysis, which indicated that, in 2010, the median number of times per day that high school students consumed fruits and vegetables was 1.2 for both. For vegetables, the median number of times per day was lower for non-Hispanic black students (1.0) and Hispanic students (1.1) than non-Hispanic white students (1.4). Overall, 28.5% of high school students consumed fruit <1 time daily, and 33.2% of high school students consumed vegetables <1 time daily. The infrequent fruit and vegetable consumption by high school students highlights the need for effective strategies to increase consumption. Policy and environmental approaches to provide greater access to and availability of fruits and vegetables are among the strategies that schools and communities might choose to achieve this goal.

NYPANS includes a school-based survey conducted by CDC in 2010 to measure dietary and physical activity behaviors and behavioral determinants. A nationally representative sample of students in grades 9--12 attending public and private schools was selected using a three-stage cluster sampling design. Students completed an anonymous, self-administered questionnaire in their classrooms during a regular class period. Response rates for schools and students were 82% and 88%, respectively, with an overall response rate† of 73%. Data from 11,429 students were available for analysis.

Respondents were asked how many times during the previous 7 days they had consumed the following: fruit, 100% fruit juice, green salad, potatoes (not including French fries, fried potatoes, or potato chips), carrots, and other vegetables. Response options were as follows: none; 1--3 times or 4--6 times during the previous 7 days; and 1, 2, 3, or 4 or more times per day.§ The two response options that included a range during the previous 7 days were assigned a value equal to the midpoint and then divided by 7 to determine daily consumption. The response option "4 or more times per day" was assigned a value of 4. Responses to the 100% fruit juice and fruit questions were summed to represent total fruit consumption, and responses to the remaining questions were summed to represent total vegetable consumption. A total of 664 students with missing data for any of the study variables were excluded, resulting in a final sample of 10,765.

Median daily consumption of fruits and vegetables was calculated among students overall and by sex, grade, and race/ethnicity. Linear contrasts were used to test differences in median consumption by demographic characteristic. Race/ethnicity data are presented for non-Hispanic white, non-Hispanic black, Hispanic (of any race) students, and students of other or multiple races. The percentage of students who consumed fruits and vegetables 0 to <1, 1 to <2, 2 to <3, 3 to <4, and ≥4 times daily was calculated among students overall and by race/ethnicity. Data were weighted to provide national estimates, and statistical software was used to account for the complex sample design.

In 2010, the reported median consumption was 1.2 times per day for both fruits and vegetables (Table). Median daily fruit consumption was significantly higher among male (1.4) than female (1.2) students and significantly lower among students in the 10th (1.2) and 12th (1.2) grades than among 9th grade students (1.4).

Although fruit consumption did not differ by race/ethnicity, median daily vegetable consumption was significantly lower among non-Hispanic black (1.0) and Hispanic (1.1) students than non-Hispanic white students (1.4) (Table). Median daily vegetable consumption did not vary significantly by sex or grade.
Overall, 28.5% of high school students consumed fruit <1 time daily, and 33.2% consumed vegetables <1 time daily (Figure). Only 16.8% consumed fruit ≥4 times daily, and 11.2% of students consumed vegetables ≥4 times daily.

Reported by
Sonia A. Kim, PhD, Kirsten A. Grimm, MPH, Diane M. Harris, PhD, Kelley S. Scanlon, PhD, Div of Nutrition, Physical Activity, and Obesity; Zewditu Demissie, PhD, EIS Officer, CDC. Corresponding contributor: Sonia A. Kim, skim3@cdc.gov, 770-488-5156.

Editorial Note
The findings in this report indicate that, in 2010, the median number of times per day that U.S. high school students consumed fruits and vegetables was only 1.2 times for both fruits and vegetables and was no higher than 1.5 for any of the demographic subpopulations studied. In addition, 28.5% of students ate fruit <1 time daily, and 33.2% of students ate vegetables <1 time daily. Consumption of vegetables was lowest among non-Hispanic black students and Hispanic students. These results make it likely that the majority of students are not meeting the daily fruit and vegetable recommendations for adolescents participating in <30 minutes of daily physical activity: 1.5 cups of fruit and 2.5 cups of vegetables for females and 2 cups of fruit and 3 cups of vegetables for males. The recommendations are higher for adolescents participating in more physical activity (1).

The infrequent fruit and vegetable consumption by high school students highlights the need for effective strategies to increase consumption. In response to consistently low fruit and vegetable intake in the population, public health agencies have begun to focus on policy and environmental approaches to improve consumption. These approaches are promising because they can have greater reach and might have longer-lasting effects than interventions such as diet counseling and education that focus on individual-level factors (4,5). Policy and environmental approaches can be used to improve fruit and vegetable access and availability, two important factors related to food choices (6).

CDC provides guidance and funding to states, territories, and communities to improve fruit and vegetable access and availability through improvements to retail stores (e.g., providing stores with equipment and training to sell a variety of fruits and vegetables), implementation of farmers' markets, and farm-to-institution policies and programs. ¶ Federal initiatives such as the Let's Move! Initiative,** Know Your Farmer, Know Your Food, †† and Communities Putting Prevention to Work§§ support environmental and policy changes to increase children's access to fruits and vegetables across multiple settings.

Because the majority of high school--aged children attend school, schools can play a prominent role in supporting fruit and vegetable consumption by providing students with fruits and vegetables and giving students opportunities to learn about and practice healthful eating behaviors. In School Health Guidelines to Promote Healthy Eating and Physical Activity, CDC recommends that schools provide access to healthy foods and encourage healthy eating choices (7). Some strategies to achieve these recommendations include salad bars, gardens, farm-to-school programs, and the U.S. Department of Agriculture's Fresh Fruit and Vegetable Program (6,7).¶¶ The Let's Move Salad Bars to Schools*** initiative, a partnership of public health organizations (including CDC), school food advocates, and the produce industry, has a goal of placing 6,000 salad bars in schools in 3 years. In addition, proposed changes to the National School Lunch and Breakfast Programs include increasing the amount and variety of fruits and vegetables offered during school meals.††† Implementing these strategies at schools can increase students' exposure to and familiarity with fruits and vegetables, factors that influence the development of food preferences (8), which, along with access, are important factors affecting food consumption (6). Also, in keeping with CDC's recommendation that schools partner with communities in the development of healthy eating (7), schools can encourage students' involvement in farm collaborations, community gardens, and improving the availability of fruits and vegetables at neighborhood stores.§§§ School and community-based experiences with fruits and vegetables might help improve the food environment, influence students to consume more of these foods (9), and create a lasting impact as adolescents become adults (10).

The findings in this report are subject to at least three limitations. First, because the survey is school-based, the results are representative only of high school students. In 2008, approximately 4% of persons aged 16--17 years nationwide were not enrolled in a high school program or did not have a high school diploma or equivalent credential.¶¶¶ Second, all results are based on self-report, and students might either overreport or underreport fruit and vegetable consumption because of social desirability or recall bias. Finally, the questionnaire assessed the number of times per day that fruit and vegetables were consumed, not the portion sizes, so direct comparisons cannot be made with dietary recommendations based on cup measurements of fruit and vegetables.

Policy and environmental approaches to increase fruit and vegetable access and availability at school and at other sites in the community where students spend time and purchase food are among the strategies that schools and communities might choose to achieve higher consumption of fruits and vegetables among high school students.

References
1.US Department of Agriculture, US Department of Health and Human Services. Dietary guidelines for Americans, 2010. 7th ed. Washington, DC: US Department of Agriculture, US Department of Health and Human Services; 2010. Available at http://www.cnpp.usda.gov/dietaryguidelines.htm. Accessed November 14, 2011.
2.Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? Nutr Rev 2004;62:1--17.
3.Kimmons J, Gillespie C, Seymour J, Serdula M, Blanck HM. Fruit and vegetable intake among adolescents and adults in the United States: percentage meeting individualized recommendations. Medscape J Med 2009:11:26.
4.Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health 2010;31:399--418.
5.Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health 2010;100:590--5.
6.Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 2008;29:253--72.
7.CDC. School health guidelines to promote healthy eating and physical activity. MMWR 2011;60(No. RR-5).
8.Birch LL. Development of food preferences. Annu Rev Nutr 1999;19:41--62.
9.Lautenschlager L, Smith C. Beliefs, knowledge, and values held by inner-city youth about gardening, nutrition, and cooking. Agriculture and Human Values. 2007;24:245--58.
10.Devine CM, Wolfe WS, Frongillo EA Jr, Bisogni CA. Life-course events and experiences: association with fruit and vegetable consumption in 3 ethnic groups. J Am Diet Assoc 1999;99:309--14.

* Additional information available at http://www.choosemyplate.gov/foodgroups/fruits_counts_table.html and http://www.choosemyplate.gov/foodgroups/vegetables_counts_table.html.

† Overall response rate = (number of participating schools / number of eligible sampled schools) × (number of usable questionnaires / number of eligible students sampled).

§ NYPANS questions included the following: "During the past 7 days, how many times did you eat fruit? (Do not count fruit juice.)"; "During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice? (Do not count punch, Kool-Aid, sports drinks, or other fruit-flavored drinks.)"; During the past 7 days, how many times did you eat green salad?"; "During the past 7 days, how many times did you eat potatoes? (Do not count French fries, fried potatoes, or potato chips.)"; "During the past 7 days, how many times did you eat carrots?"; "During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.)" For each question, the response options were as follows: I did not eat [fruit item or vegetable item] (or drink 100% fruit juice) during the past 7 days, "1 to 3 times during the past 7 days," "4 to 6 times during the past 7 days," "1 time per day," "2 times per day," "3 times per day," and "4 or more times per day."

¶ Additional information available at http://www.cdc.gov/obesity/stateprograms/fundedstates.html.

** Additional information available at http://letsmove.gov/.

†† Additional information available at http://www.usda.gov/wps/portal/usda/knowyourfarmer?navid=KNOWYOURFARMER.

§§ Additional information available at http://www.cdc.gov/healthycommunitiesprogram/communities/cppw/index.htm.

¶¶ Additional information available at http://www.fns.usda.gov/cnd/ffvp.

*** Additional information available at http://saladbars2schools.org/.

††† Additional information available at http://www.fns.usda.gov/cnd/governance/regulations/2011-01-13.pdf .

§§§ Additional information available at http://www.thefoodtrust.org/php/programs/Summer2011issuebrief.pdf .

¶¶¶ Additional information available at http://nces.ed.gov/pubs2011/2011012.pdf .

full-text:
Fruit and Vegetable Consumption Among High School Students — United States, 2010