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Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition Methodology & Assessment".

Deadline for manuscript submissions: closed (20 September 2021) | Viewed by 39718

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Dr. Jennifer Di Noia

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Department of Sociology and Criminal Justice, William Paterson University, Wayne, NJ 07470, USA
Interests: nutrition; health disparities; health promotion; health behavior change

Special Issue Information

Dear Colleagues,

Whole grains, non-starchy vegetables, fruit, and beans are a consistent feature of diets associated with a lower risk of cancer and other diet-related diseases. Fruits and vegetables also play an important role in weight management and are promoted for obesity prevention because of their low energy density, higher fiber content, and satiety value. The importance of fruits and vegetables as part of a healthy diet is illustrated by the MyPlate food guidance system, which encourages consumers to fill half their plate with fruits and vegetables. Low income is a risk factor for low fruit and vegetable intake, and increasing consumption in low-income segments of the population may help to redress socioeconomic inequalities in health. Systematic reviews and meta-analyses of interventions to date find small positive effects on intake, highlighting the need for research to improve understanding of “what works” for low-income groups. In light of the lack of methods beyond traditional dietary assessment tools and techniques, there also is a need to identify novel methods to assess and track changes in intake.

In light of your expertise, you are invited to submit original research (including short communications of preliminary but significant results), reviews (narrative or systematic), or meta-analyses for this Special Issue of Nutrients focused on innovative approaches to assessing and modifying fruit and vegetable intake in low-income populations.

Dr. Jennifer Di Noia
Guest Editor

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Keywords

Fruit and vegetable consumption
Low-income populations
Health disparities
Dietary assessment
Dietary intervention
Health promotion

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Published Papers (12 papers)

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Research

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14 pages, 295 KiB

Open AccessArticle

An Investigation of Social Ecological Barriers to and Facilitators of WIC Farmers Market Nutrition Program Voucher Redemption

by Renata Blumberg, Emily Fowler, Yeon Bai, Pankaj Lal, Alyssa Smolen and Ilana Dubrovsky

Nutrients 2022, 14(9), 1871; https://doi.org/10.3390/nu14091871 - 29 Apr 2022

Cited by 4 | Viewed by 2413

Abstract

In the United States, many communities lack sufficient access to fresh produce. To improve access to fresh fruits and vegetables, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides eligible participants vouchers through the Farmers Market Nutrition Program (FMNP) that can be redeemed directly from farmers at markets or farm stands. However, FMNP voucher redemption rates in New Jersey remain lower than those in neighboring states. This article used the social ecological model to examine differences between FMNP participants who redeem vouchers (Redeemers) and those who do not (non-Redeemers) in the areas of: produce procurement practices and consumption frequency, and barriers to and facilitators of FMNP voucher redemption. This cross-sectional study included WIC FMNP participants (N = 329) in northern New Jersey, USA. Analyses were conducted using descriptive statistics, independent sample t-tests, and one-way ANOVA. Compared to Redeemers, non-Redeemers consumed fewer average daily vegetable servings, were more likely to shop at small grocery/corner stores, and encountered significant barriers to FMNP redemption, e.g., difficulty finding time to redeem vouchers. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

13 pages, 422 KiB

Open AccessFeature PaperArticle

Farmers’ Market Nutrition Program Educational Events Are Broadly Accepted and May Increase Knowledge, Self-Efficacy and Behavioral Intentions

by Karla L. Hanson, Xiangqi Meng, Leah C. Volpe, Stephanie Jilcott Pitts, Yvonne Bravo, Jennifer Tiffany and Rebecca A. Seguin-Fowler

Nutrients 2022, 14(3), 436; https://doi.org/10.3390/nu14030436 - 19 Jan 2022

Cited by 5 | Viewed by 2585

Abstract

The Farmers’ Market Nutrition Program (FMNP) in the U.S. provides coupons for the purchase of fruit and vegetables (FV) to pregnant women and children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and to income-eligible adults 60+ years of age. The New York State FMNP Education Event Guide was developed to support cooperative extension educators in providing information, food tastings, and cooking demonstrations at farmers’ markets (FM) to encourage consumption of FV. This paper describes implementation at seven FM in New York City, and shopping and eating behaviors in a cross-sectional survey of FM shoppers (n = 377). Three of nine lessons were implemented more than once, typically with food sampling (78.9%). FM shoppers were primarily women (81.5%), racially diverse (30.5% Black, 23.1% White), frequent shoppers (2.4 times/month), and had high FV consumption (2.24 cups fruit; 2.44 cups vegetables daily). Most FM shoppers participated in the FM education event (84%), and participants and non-participants had equivalent shopping and eating behaviors. More than 70% of FM education participants believed that the event positively impacted their knowledge, self-efficacy, and behavioral intentions. FMNP education events at FM were broadly accepted by FM shoppers of all characteristics, and may improve knowledge, self-efficacy, and behavioral intention. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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12 pages, 267 KiB

Open AccessCommunication

Measuring Skin Carotenoids Using Reflection Spectroscopy in a Low-Income School Setting

by Anna M. Jones, Angie Keihner, MaryAnn Mills, Barbara MkNelly, Kamaljeet K. Khaira, Jona Pressman and Rachel E. Scherr

Nutrients 2021, 13(11), 3796; https://doi.org/10.3390/nu13113796 - 26 Oct 2021

Cited by 8 | Viewed by 2386

Abstract

Dietary behavior change is difficult to accurately measure in a low-income youth population. Objective tools to measure fruit and vegetable consumption without relying on self-report present the opportunity to do this with less respondent burden and bias. A promising tool for quantifying fruit and vegetable consumption via proxy is skin carotenoids as measured by reflection spectroscopy through a device called the Veggie Meter^®. To assess whether the Veggie Meter^® is able to detect changes in skin carotenoids as a proxy for fruit and vegetable consumption in a low-income school setting, skin carotenoid measurements were collected at three time points, along with student level demographics, anthropometric measurements, and nutrition knowledge. A secondary goal of this study was to refine the protocol to be used based on researcher observations. Repeated measures analysis of variance with Bonferroni correction for multiple comparisons indicate that there was a significant difference in VM scores over the course of the study (F(2, 68) = 6.63, p = 0.002), with an increase in skin carotenoids from Fall 2018 to Spring 2019 (p = 0.005). This increase was sustained over the summer months when measured in Fall 2019. Changes to the protocol included the addition of a hand cleaning step and using the non-dominant ring finger for data collection. With these refinements, the results demonstrate that the Veggie Meter^® is usable as a non-invasive tool for measuring fruit and vegetable consumption in a population that is traditionally difficult to assess. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

12 pages, 3662 KiB

Open AccessArticle

Acceptability of Vegetable Fortified Ugali in Sub-Saharan Africa

by Zixuan Cai, Xin Meng, Dennis Nyirenda, Wilson Mandala, Xiaoyun Li and Dong Yang

Nutrients 2021, 13(10), 3405; https://doi.org/10.3390/nu13103405 - 27 Sep 2021

Cited by 2 | Viewed by 2413

Abstract

Corn flour-based porridge like dough, ugali, is the staple food of low-income population in sub-Saharan Africa. Lack of vitamin A, carotenoids, and dietary fibers brings about serious health issues to this population. In this study, vegetables including bok choy, broccoli, cabbage, carrot, Chinese onion stalk (C_onion), mushroom, are added during the cooking of ugali, as nutritional supplements. The freeze-dried powder of each vegetable was used for its long storage, stable nutrients, and similar particle size. Sub-Saharan African assessors were trained and sensory evaluated the six different vegetable fortified ugali with the plain, unfortified as the control on five attributes. The plain ugali was indistinguishable with the C_onion stalk fortified in color, with the carrot and C_onion stalk fortified in odor, with all vegetables (except broccoli and mushroom) fortified ugali in taste, with carrot and C_onion stalk fortified in granularity, and with cabbage, carrot, C_onion stalk fortified in viscosity. Preference ranking analysis showed that the C_onion stalk fortified ugali is even more favorably preferred than the plain, unfortified ugali, probably due to the umami components in C_onion that serve as the taste enhancer. This study indicates that Chinese onion stalk is a potential vegetable supplement to population in the sub-Saharan Africa. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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11 pages, 287 KiB

Open AccessArticle

Wellness in the Schools: A Lunch Intervention Increases Fruit and Vegetable Consumption

by Pamela A. Koch, Randi L. Wolf, Raynika J. Trent, Ian Yi Han Ang, Matthew Dallefeld, Elizabeth Tipton, Heewon L. Gray, Laura Guerra and Jennifer Di Noia

Nutrients 2021, 13(9), 3085; https://doi.org/10.3390/nu13093085 - 2 Sep 2021

Cited by 3 | Viewed by 3815

Abstract

Wellness in the Schools (WITS) is a national non-profit organization partnering with public schools to provide healthy, scratch cooked, less processed meals (called an Alternative Menu), and active recess. This study examined the effects of WITS programming on school lunch consumption, including fruit and vegetable intake, in second and third grade students in New York City public schools serving a high proportion of students from low-income households. The intervention was evaluated with a quasi-experimental, controlled design with 14 elementary schools (7 that had initiated WITS programming in fall 2015 and were designated as intervention schools, and 7 matched Control schools). School lunch consumption was assessed by anonymous observation using the System of Observational Cafeteria Assessment of Foods Eaten (SOCAFE) tool in the fall of 2015 (Time 0, early intervention) and the spring of 2016 (Time 1) and 2017 (Time 2). There were no baseline data. Data were also collected on the types of entrées served in the months of October, January, and April during the two school years of the study. Across time points, and relative to students in the Control schools, students in WITS schools ate more fruits and vegetables (units = cups): Time 0: Control 0.18 vs. WITS 0.28; Time 1: Control 0.25 vs. WITS 0.31; and Time 2: Control 0.19 vs. WITS 0.27; p < 0.001. They also had more fruits and vegetables (cups) on their trays, which included more vegetables from the salad bar. However, students in the WITS schools ate fewer entrées (grain and protein) and drank less milk than students in the Control schools. Compared to the Control schools, WITS schools offered more homestyle entrées and fewer finger foods and sandwich entrees, i.e., less processed food. Students in WITS schools who received the Alternative menu and all of the WITS programming at all data collection time points selected and consumed more fruits and vegetables. Replication studies with randomized designs and true baseline data are needed to confirm these findings and to identify avenues for strengthening the effects of the program on other school lunch components. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

13 pages, 1351 KiB

Open AccessArticle

A Randomized Controlled Trial Evaluating the FIT Game’s Efficacy in Increasing Fruit and Vegetable Consumption

by Heidi J. Wengreen, Damon Joyner, Sheryl S. Kimball, Sarah Schwartz and Gregory J. Madden

Nutrients 2021, 13(8), 2646; https://doi.org/10.3390/nu13082646 - 30 Jul 2021

Cited by 9 | Viewed by 2779

Abstract

Few children eat the recommended amounts of fruits and vegetables (FV). Although incentive-based interventions can increase FV consumption, this approach is costly and may be viewed as controversial due to the possible negative effects on intrinsic motivation. The FIT Game was designed to address these challenges. Four elementary schools were randomly assigned to either cooperatively play the FIT Game (n = 881) for ~8 weeks or to a no-game Control condition (n = 978). The FIT Game was presented daily as comic-book formatted episodes projected onto a large screen in the school cafeteria throughout lunchtime. All children could see the episodes which communicated daily whole-school vegetable-eating goals and illustrated the progress of the game’s heroes when these goals were collectively met. Photo estimates of FV consumption and skin carotenoid concentrations (biomarker of carotenoid consumption) were collected at baseline, during the last 5 days of the FIT Game, and 3 months after the intervention concluded. Control schools followed the same FV consumption-monitoring procedures for the same duration. At the conclusion of the intervention phase, children attending the FIT Game schools consumed more vegetables (d = 0.41), more fruit (d = 0.39), and had higher skin carotenoids (d = 0.66) than at baseline. These statistically significant increases were maintained at a 3-month follow-up for vegetables (d = 0.21, the food targeted for change) and carotenoids (d = 0.53). Thus, the no-cost virtual incentives of the FIT Game increased FV consumption in the short- and long-run, without negatively impacting intrinsic motivation. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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10 pages, 282 KiB

Open AccessArticle

Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security

by Amy Saxe-Custack, Jenny LaChance, Jennifer Jess and Mona Hanna-Attisha

Nutrients 2021, 13(8), 2619; https://doi.org/10.3390/nu13082619 - 29 Jul 2021

Cited by 15 | Viewed by 3299

Abstract

Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p < 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p < 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

12 pages, 472 KiB

Open AccessArticle

Higher Fruit and Vegetable Intake Is Associated with Participation in the Double Up Food Bucks (DUFB) Program

by Abiodun T. Atoloye, Mateja R. Savoie-Roskos and Carrie M. Durward

Nutrients 2021, 13(8), 2607; https://doi.org/10.3390/nu13082607 - 29 Jul 2021

Cited by 8 | Viewed by 2760

Abstract

Incentivizing fruit and vegetable (F&V) purchases may help address barriers to healthy eating among populations with low income. In a repeated measures natural experiment study, we examined whether participation in the Double Up Food Bucks (DUFB) program increased F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients. Two hundred and twelve participants recruited at baseline through telephone calls were informed about the availability of DUFB at their local farmers’ market (FM). F&V consumption frequency and DUFB use were obtained at baseline, mid FM, and end of FM season approximately 5 months later. Participants (N = 212) were primarily white (76.4%) women (77.3%) with an average age of 43.5 years. Only 34 participants opted to use the DUFB program. A linear mixed model showed a significant main effect of DUFB use (p = 0.001) and of time (p = 0.002), with a decrease in F&V intake over time. Compared to non-users, DUFB users had a significantly higher F&V consumption at baseline and midpoint (p = 0.02 and p = 0.02, respectively). F&V consumption was associated with participation in the DUFB program and higher F&V consumption frequency was observed prior to program use among program participants. Future interventions that specifically target SNAP recipients with low F&V intake to use the DUFB program are needed. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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12 pages, 303 KiB

Open AccessArticle

Use of the Spectroscopy-Based Veggie Meter^® to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults

by Jennifer Di Noia and Werner Gellermann

Nutrients 2021, 13(7), 2270; https://doi.org/10.3390/nu13072270 - 30 Jun 2021

Cited by 16 | Viewed by 4724

Abstract

Reflection spectroscopy is an emerging approach for noninvasively assessing dermal carotenoids as a biomarker of fruit and vegetable (FV) intake. This study sought to profile and identify determinants of scores from a reflection spectroscopy device (the Veggie Meter (VM)^®) among 297 urban, primarily Hispanic low-income adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The repeatability of the scores and bi- and multivariate relationships between VM scores, self-reported FV intake measured by a brief screener, and participant characteristics were examined. The mean VM score was 270 (range 0–695); 3- and 6-month test-retest correlations were positive and strong (r = 0.79 and 0.55, respectively). VM scores were negatively associated with body mass index (BMI; r = −0.22) and were higher among participants of Ecuadorian, Dominican, and Mexican Hispanic origin relative to those of Puerto Rican origin; foreign- vs. US-born participants, breastfeeding vs. non-breastfeeding participants, nonsmokers vs. smokers, and participants who consumed three or more cups of FV/day relative to those who consumed less than three cups of FV/day. Foreign-born nativity, consumption of three or more cups of FV/day, and smaller body size were determinants of increased VM scores. Although replication studies are needed to confirm these findings, investigators working with similar populations are encouraged to use the VM to longitudinally track FV intake and to target determinants of the scores in observational and intervention studies of FV intake as measured by the VM. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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14 pages, 457 KiB

Open AccessReview

Family-Based Obesity Prevention Interventions among Hispanic Children and Families: A Scoping Review

by Erica G. Soltero, Armando Peña, Veronica Gonzalez, Edith Hernandez, Guisela Mackey, Chishinga Callender, Jayna M. Dave and Debbe Thompson

Nutrients 2021, 13(8), 2690; https://doi.org/10.3390/nu13082690 - 3 Aug 2021

Cited by 15 | Viewed by 7093

Abstract

This scoping review examined intervention and sample characteristics of family-based obesity prevention interventions among Hispanic youth. This review also examined the degree to which existing interventions were culturally-adapted, acknowledged social determinants of health (SDoH), and collaborated with community stakeholders. A comprehensive search across Medline Ovid, Embase, Scopus, PsycInfo, and Pubmed was used to identify 13 studies primarily based in the U.S. (92.3%). Data was extracted by two independent reviewers. Most used a randomized control trial design (69.2%), a behavior change theory (84.6%), and reported moderate to high (≥70%) retention (69.2%). Studies targeted improvements in physical activity (69.2%) and fruit and vegetable intake (92.3%) through nutrition education, cooking demonstrations, and tastings. Younger children from low socioeconomic backgrounds (61.5%) were well represented. Most interventions were culturally-adapted (69.2%), all studies reported collaboration with stakeholders, yet only half used strategies that acknowledged SDoH (46.2%). To increase our understanding of the underlying mechanisms by which family-based approaches can reach and engage Hispanic youth and families, future studies should rigorously evaluate theoretical constructs, family processes, and SDoH that influence program participation and health behaviors. This information will guide the design and development of future interventions aimed at reducing obesity disparities among Hispanic youth. Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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2 pages, 181 KiB

Open AccessReply

Reply to Byker Shanks et al. Measurement of Fruit and Vegetable Intake Incorporating a Diversity, Equity, and Inclusion Lens. Comment on “Di Noia, J.; Gellermann, W. Use of the Spectroscopy-Based Veggie Meter^® to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults. Nutrients 2021, 13, 2270”

by Jennifer Di Noia and Werner Gellermann

Nutrients 2022, 14(4), 811; https://doi.org/10.3390/nu14040811 - 15 Feb 2022

Viewed by 1257

Abstract

We thank Byker Shanks et al. [...] Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

2 pages, 185 KiB

Open AccessComment

Measurement of Fruit and Vegetable Intake Incorporating a Diversity, Equity, and Inclusion Lens. Comment on Di Noia, J.; Gellermann, W. Use of the Spectroscopy-Based Veggie Meter^® to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults. Nutrients 2021, 13, 2270

by Carmen Byker Shanks, Betty Izumi, Courtney A. Parks and Amy L. Yaroch

Nutrients 2022, 14(4), 809; https://doi.org/10.3390/nu14040809 - 15 Feb 2022

Cited by 2 | Viewed by 2163

Abstract

Disparities in fruit and vegetable intake (FVI) and diet-related diseases exist among low-income and racial/ethnic minority populations [...] Full article

(This article belongs to the Special Issue Fruit and Vegetable Consumption: Innovative Approaches to Assessment and Intervention with Low-Income Populations)

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