RESEARCH Original Research Increasing Child Fruit and Vegetable Intake: Findings from the US Department of Agriculture Fresh Fruit and Vegetable Program Lauren E. W. Olsho, PhD; Jacob Alex Klerman, MA; Lorrene Ritchie, PhD, RD; Patricia Wakimoto, DrPH, RD; Karen L. Webb, PhD, MPH; Susan Bartlett, PhD ARTICLE INFORMATION Article history: Submitted 18 November 2013 Accepted 30 December 2014 Available online 3 March 2015 Keywords: Fruit and vegetable intake School nutrition Impact evaluation Fresh Fruit and Vegetable Program Regression discontinuity 2212-2672/Copyright ª 2015 by the Academy of Nutrition and Dietetics. http://dx.doi.org/10.1016/j.jand.2014.12.026 ABSTRACT Background Fewer than 10% of US children and adolescents consume the recom- mended amounts of fruits and vegetables (F/V). The US Department of Agriculture’s Fresh Fruit and Vegetable Program (FFVP) is intended to increase child F/V consumption by funding low-income schools to distribute free fresh F/V snacks outside of school mealtimes. Objective The evaluation assessed FFVP effects on student F/V consumption and total energy intake in and out of school. Design The evaluation employed a regression discontinuity design; that is, cross- sectional comparisons of a sample of students in schools just above and just below the FFVP funding cutoff for the program, which depended on the proportion of students eligible for free or reduced-price meals. During the 2010-2011 school year within a randomly selected sample of states, we selected schools in closest proximity to each state-specific FFVP funding cutoff. Interviewers conducted 24-hour diary-assisted recall interviews to assess dietary intake among children in selected schools. Participants/setting Participants were 4,696 students (grades 4 to 6) from 214 elementary schools in 16 randomly selected states. Statistical analyses performed Analysis proceeded via multivariate regression, comparing adjusted mean student intake in schools just above and just below the funding cutoff. Results Adjusted mean daily F/V intake was one-third of a cup per day higher in FFVP- participating schools than in nonparticipating schools (0.32 cups per day; P<0.001), a difference of 15.5%. This included one-quarter cup higher daily F/V intake during school hours (0.26 cups; P<0.001) among students attending FFVP-participating schools. Fresh (but not total) F/V consumption also increased outside of school. Conclusions The FFVP increases child fresh and total F/V intake in school, and fresh F/V intake outside of school. J Acad Nutr Diet. 2015;115:1283-1290. T HE 2010 DIETARY GUIDELINES FOR AMERICANS provide recommendations for fruit and vegetable (F/V) intake depending on age, sex, and activity level. 1 For elementary schooleaged children, recom- mended F/V intake ranges from 2 1 / 2 cup-equivalents per day (for a sedentary 5-year-old boy or girl taking in 1,200 cal- ories per day) up to 5 cup-equivalents per day (for an active 10- or 11-year-old boy taking in 2,200 calories per day), where 1 cup-equivalent is equal to two servings. 1 With <10% of US children and adolescents consuming recom- mended amounts of F/V, 2,3 increasing F/V consumption is a potentially important strategy for improving diet quality in this group. 4 Epidemiologic studies have shown that increased con- sumption of F/V is associated with a reduction in long-term risk of obesity. 5,6 Because F/V are relatively high in water and fiber, their increased consumption is thought to contribute to lower overall dietary energy density and total energy intake. Consistent with this hypothesis, experimental interventions involving the addition of F/V to the diet have demonstrated short-term effectiveness in reducing body weight, particularly when paired with advice to reduce di- etary fat and/or overall energy intake. 7-9 In addition, epide- miologic and cohort studies have consistently found a relationship between increased F/V consumption and reduced risk of heart disease and some cancers. 10-12 For many students, a large share of total daily food and nutrients 13,14 and most F/V 15 are eaten at school. School is, therefore, a promising context in which to intervene to in- crease child F/V intake. 16-18 The US Department of Agriculture (USDA) funds the Fresh Fruit and Vegetable Program (FFVP) as one component of broader school-based efforts to improve child nutrition. The FFVP is intended to increase student F/V intake while teaching children more healthful eating habits. ª 2015 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1283