Background: While farmers' markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers' markets among rural residents. Thus, this study's purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers' market shopping in southern rural communities; and (3) associations between farmers' market use with fruit and vegetable consumption and body mass index (BMI). Methods. Cross-sectional surveys were conducted with a purposive sample of farmers' market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers' markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers' market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers' market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers' market shopping. Linear regression analyses were used to examine associations between farmers' market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender. Results: Among farmers' market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers' market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers' market shopping were market days and hours, "only come when I need something", extreme weather, and market location. Among the KY farmers' market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers' markets. There were no associations between use of farmers' markets and BMI. Conclusions: Fruit and vegetable consumption was associated with farmers' market shopping. Thus, farmers' markets may be a viable method to increase population-level produce consumption.

Researchers in the Psychology Department and the Nutrition, Dietetics, and Food Sciences Department sought to improve elementary school children’s in-school fruit and vegetable (FV) consumption. To achieve this goal, a program that has proven effective in the UK called the Food Dudes (FD) program was implemented in six local schools. Schools were assigned to either experience the traditional FD program (with prize rewards, such as pencil cases and bubbles), a modified version of the FD program (with praise rewards replacing the prize rewards), or no FD program (the control group). Students who consumed a pre-specified amount of FV each day during the intervention earned a reward according to the program’s schedule. Results showed that students in the Prize schools were consuming more FV than students in the Praise schools and the Control schools at follow-up when the intervention had been removed for six months. While the success of the FD program with prize rewards (i.e., incentives) was encouraging, many teachers reported issues with its implementation. An incentive-based intervention may be difficult for schools to implement due to high labor and material costs, especially without outside assistance. Therefore, we aimed to reduce these costs while maintaining the use of incentives. We developed an intervention based on the principles of gamification in which students earned in-game, virtual rewards for meeting their FV consumption goals each day at school. This intervention was rated favorably by teachers and parents and showed significant increases in school-wide and individual FV consumption in two schools in Logan, UT, but long-term increases were not obtained. Improving children’s dietary decisions, namely FV consumption, is an important goal that can positively impact future health. Sustainable, incentive-based interventions, like the school-wide gamification model developed in this project, represent a promising step toward achieving this goal.

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The US and Japanese populations do not meet recommended DF intakes. This study indicated the relationship between the variety of vegetables available in markets and vegetable consumption in the US and Japan. The number of vegetables available in markets was determined using online resources from five markets in each country. Mean number of vegetable products in the US was 104.4 products (SD: ±36.8) and mean number of vegetable products in the Japanese markets was 120.2 products (SD: ±15.6). There was no significant relationship between the variety of vegetables in markets and vegetable consumption between the US and Japan. This study identified how to measure the variety of vegetables available in markets through online resources. Future studies should consider more effective methodology to measure the variety of vegetables, increase sample size, and find accurate resources, such as for the measurement of food diversity and more detailed data from NHANES and NHNS.

Recent nutrition reports conclude that changing dietary practices is a strategic way to reduce cancer rates in the United States. Nutrition recommendations to decrease risk of cancer include reducing fat intake to 30% of total calories, increasing fiber consumption to 20-30 g/day, and increasing fruit and vegetable consumption to five servings daily. However, recent studies suggest that fruit and vegetable consumption decreases with educational and income levels within a population, and that blue-collar workers tend to consume 38-40% of total calories as fat. It is possible that national campaign efforts to change dietary practices are not reaching educationally and economically challenged populations. This research identifies the perceptions of blue-collar workers regarding a link between dietary practices and disease prevention. Six focus groups, three of women and three of men were conducted in urban, suburban, and rural Virginia counties. A total of 66 workers participated, and each group was comprised of 8-16 blue-collar workers 35-65 years of age. Most participants were aware of a link between dietary practices and health. A "healthy person" was described as eating low fat foods, fruits and vegetables, and maintaining a healthy weight. Fatty meat consumption, food processing, and chemical treatment of food were perceived as increasing risk for disease. Few participants were aware of a potential link between diet and cancer. Many contributed risk for cancer to factors beyond their control such as heredity, environmental factors, and the influence of the food industry. Those who had experienced a disease, either themselves or through a loved one expressed a greater sense of urgency to modify their eating habits. Most of those attempting dietary modification were addressing health issues relating to cardiovascular disease. The majority reported consuming less than five servings of fruits and vegetables daily, most often as canned or frozen products. Participants reported receiving nutrition education from non-interactive sources, such as television, newspapers, magazines, and radio, and interactive sources such as health professionals and community programs. Those that mentioned interactive sources were more likely to elaborate on specific information learned. Television segments, newsletters, and worksite programs were selected as the most preferred ways to receive nutrition education. When asked what topics would be most helpful in a newsletter series, people requested information regarding heart disease more frequently than cancer. Health benefits of fruit and vegetable consumption, menus, and recipes were also mentioned. The findings suggest that nutrition education efforts concerning cardiovascular disease have penetrated the blue collar population. Community educators need to broaden messages to include current information regarding the potential link between dietary practices and cancer. Furthermore, 35-65 year olds may exhibit more willingness to change dietary habits through nutrition education due to changes in health among themselves or loved ones. / Master of Science

The problem of this investigation was to survey the noon-meal vegetable consumption of 248 elementary-school children in the J. M. Lindsay School, Gainesville, Texas, for a period of ten days, and to compile lists of the vegetables which the children indicated that they liked or disliked.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / Consumption of fruits and vegetables (FV) contributes to healthy growth and development among youth. For effective intervention development, an understanding of the underlying casual influences on consumption is needed. The current dissertation is intended to identify whether influences on youth fruit and vegetable consumption (FVC) vary by age, gender, ethnicity and socioeconomic status (SES). The series of four chapters focus on self-efficacy for FVC and proxy efficacy to influence other adults to provide supportive FV environments. Chapter One reviews studies examining the influences on youth FVC. Consistently across studies, FV preferences and FV availability influenced youth FVC. Chapter Two and Chapter Three report studies documenting that children's confidence (proxy efficacy) to influence parents to make FV available and to influence other adults (after-school staff) to make FV available are independent but related constructs to self-efficacy to eat fruits and self-efficacy to eat vegetables. Differences were found in these constructs according to school demographic variables and youth demographic variables. Chapter Two reports that youth attending elementary schools with lower concentrations of racial/ethnic diversity and higher concentrations of high SES were more confident in influencing their parents to make FV available than youth attending schools with higher concentrations of racial/ethnic diversity and higher concentrations of low SES. Although analyses of cross sectional data collected on elementary-aged youth presented in Chapter 3 showed no demographic differences at the school level, Chapter Four examined longitudinal data across sixth-, seventh- and eighth-grade and found demographic differences using youth level variables. Across the middle school years, youth declined in proxy efficacy and racial/ethnic minority youth declined at a significantly faster rate than white youth. Each year, male and lower SES youth were significantly lower in proxy efficacy than females and higher SES youth, respectively. Thus, school or youth demographic differences in self-efficacy and proxy efficacy may contribute to the understanding of why males and lower SES youth eat less FV than females and higher SES youth.

School garden-based education programs have become an increasingly popular tool to improve children's nutrition, yet evaluations have found mixed results. This study analyzes three years of student surveys collected before and after one year of participation in the American Heart Association's Teaching Gardens program. Analysis was guided by the Social Cognitive Theory, and measured changes in determinants of healthy eating behavior: preferences for fruits and vegetables, gardening skills, food systems learning, and perceptions of self-efficacy and social norms regarding fruit and vegetable consumption. A total of 755 pre-test and 976 post-test responses were included in the analysis, as well as 173 pre-test and 146 post-test responses from two control schools that did not participate in any gardening activities. Frequencies and crosstabulations were used to analyze pre- and post-test data. Paired t-tests were also used to analyze differences between pre- and post-test when data were collected for the same student before and after Teaching Gardens participation. Paired t-test results indicated improvement in Preferences, Food Systems Learning, and Social Norms for both control and experimental groups and in Gardening Skills for the experimental group, although none of the changes over time were significant. At posttest, significant differences by gender were found in responses across all five indices, with girls answering generally more positively to questions than boys. Crosstab results also indicated significant differences by school minority concentration and socioeconomic status (SES) across all five indices at post-test, as well as a general correlation between minority concentration and SES. However, the effects of these environmental factors were mixed. The second article of this thesis investigates the effects of another environmental factor - the level of integration of the school garden program into the wider school environment - on students' reported knowledge of Gardening Skills. Eight schools and 142 matched pairs of students that participated in the Teaching Gardens program were analyzed. Adult responses from each of the schools were used to create an index of the program's Level of Integration, which was then compared with the students' reported changes in Gardening Skills using bivariate analysis and Paired Samples t-tests. Repeated Measures General Linear Model tests were then conducted to compare the model including the Level of Integration against the more traditional model of school garden evaluation, which focuses on school's minority concentration and SES. Results indicate that students at schools with well-integrated school garden programs gain greater Gardening Skills as a result of one year of participation in the program and confirms previous findings that students from lower SES areas experience greater gains in Gardening Skills than students from higher SES areas.

Individuals who are disadvantaged by low-income and/ or minority status face a number of barriers to experiencing optimal health and eating well. Twenty Aboriginal and 29 non-Aboriginal participants (N = 49) from Ottawa, Canada took part in a cross-sectional, mixed methods study and completed one questionnaire and single in-depth interview that verified: 1) food security status and household eating habits, 2) fruit and vegetable purchase and consumption, and 3) knowledge about or participation in the Good Food Box [GFB] Program. Ottawa GFB staff (n = 5), site coordinators (n = 6) and steering committee members (n = 3) took part in separate discussion groups to identify challenges and strengths related to program coordination, management and delivery. Within an ecological framework, qualitative data is discussed using a social phenomenological and thematic approach. Using χ2 analyses, results suggest a medium effect size and association between food security status and Aboriginal identity (χ2(1) = 8.04, p < 0.01; φ = 0.4) and satisfaction with how stores meet household food needs and gender (χ2(1) = 5.86, p < 0.05; φ = 0.36). A relationship between participation in the GFB Program and food security status (χ2(1) = 11.13, p < 0.01; φ = 0.48) is also shown where estimates suggest that GFB customers are 9.9 times more likely to be food secure compared to non-affiliates. ANOVA results and post-hoc tests demonstrate a significant mean difference in frequency of fruit consumption between GFB customers and non-program users (F(2, 46) = 11.29, p = 0.00) where 29.6% of the variance (ω2 = 0.296) is explained by program participation. Results-based and community-driven recommendations to improve access to healthy food, food security and the GFB Program are discussed as shared responsibilities between different levels of government across sectors and the community since these are public and social health issues, determinants of health and economic concerns. Implications of findings are also discussed.