Effect of Ending the Nationwide Free School Fruit Scheme on the Intake of Fruits, Vegetables, and Unhealthy Snacks in Norwegian School Children Aged 10–12 Years
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Sample
2.2. The Questionnaires
2.3. Statistical Analysis
2.4. Ethic
3. Results
4. Discussion
Areas for Further Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Global Strategy on Diet, Physical Activity and Health; World Health Organization: Geneva, Switzerland, 2004.
- Lassi, Z.M.A.; Bhutta, Z. Nutrition in Middle Childhood and Adolescence. In Child and Adolescent Health and Development, 3rd ed.; Bundy, D.A., de Silva, N., Horton, S., Patton, G.C., Schultz, L., Jamison, D.T., Eds.; The International Bank for Reconstruction and Development/The World Bank: Washington, DC, USA, 2017. [Google Scholar]
- World Cancer Research Fund, American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: A Global Perspective; A Summary of the Third Expert Report 2018; World Cancer Research Fund, American Institute for Cancer Research: Washington, DC, USA, 2018; 116p. [Google Scholar]
- Gbd 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019, 393, 1958–1972. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Darfour-Oduro, S.A.; Buchner, D.M.; Andrade, J.E.; Grigsby-Toussaint, D.S. A comparative study of fruit and vegetable consumption and physical activity among adolescents in 49 Low-and-Middle-Income Countries. Sci. Rep. 2018, 8, 1623. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. Regional Office for Europe. Food and Nutrition Policy for Schools: A Tool for the Development of School Nutrition Programmes in the European Region Copenhagen; Report No.: EUR/06/5073063 Contract No.: EUR/06/5073063; World Health Organization, Regional Office for Europe: Copenhagen, Denmark, 2006.
- FAO. Regulation (EU) No 1308/2013 of the European Parliament (2009); FAO: Rome, Italy, 2009. [Google Scholar]
- Haß, J.; Lischetzke, T.; Hartmann, M. Does the distribution frequency matter? A subgroup specific analysis of the effectiveness of the EU School Fruit and Vegetable Scheme in Germany comparing twice and thrice weekly deliveries. Public Health Nutr. 2018, 21, 1375–1387. [Google Scholar] [CrossRef] [Green Version]
- Wolnicka, K.; Taraszewska, A.M.; Jaczewska-Schuetz, J. Can the School Fruit and Vegetable Scheme Be an Effective Strategy Leading to Positive Changes in Children’s Eating Behaviours? Polish Evaluation Results. Int. J. Environ. Res. Public Health 2021, 18, 12331. [Google Scholar] [CrossRef] [PubMed]
- European Commission Dg-boaRD. Evaluation Support Study of the EU School Fruit, Vegetables and Milk Scheme: Final Report; Publications Office of the European Union: Luxembourg, 2022. [Google Scholar]
- Ohri-Vachaspati, P.; Dachenhaus, E.; Gruner, J.; Mollner, K.; Hekler, E.B.; Todd, M. Fresh Fruit and Vegetable Program and Requests for Fruits and Vegetables Outside School Settings. J. Acad. Nutr. Diet. 2018, 118, 1408–1416. [Google Scholar] [CrossRef]
- Amini, M.; Najafi, F.; Karyani, A.K.; Pasdar, Y.; Samadi, M.; Moradinazar, M. Does socioeconomic status affect fruit and vegetable intake? Evidence from a cross-sectional analysis of the RaNCD Cohort. Int. J. Fruit Sci. 2021, 21, 779–790. [Google Scholar] [CrossRef]
- Fismen, A.S.; Smith, O.R.F.; Torsheim, T.; Rasmussen, M.; Pedersen Pagh, T.; Augustine, L.; Ojala, K.; Samdal, O. Trends in food habits and their relation to socioeconomic status among Nordic adolescents 2001/2002-2009/2010. PloS ONE 2016, 11, e0148541. [Google Scholar] [CrossRef] [Green Version]
- Garcia, A. Is health promotion relevant across cultures and the socioeconomic spectrum? Fam. Community Health 2006, 29, 20s–27s. [Google Scholar] [CrossRef]
- Stea, T.H.; Hovdenak, I.M.; Rønnestad, J.; Rennestraum, K.; Vik, F.N.; Klepp, K.-I.; Bere, E. Effects of 1 y of free school fruit on intake of fruits, vegetables, and unhealthy snacks: 14 y later. Am. J. Clin. Nutr. 2018, 108, 1309–1315. [Google Scholar] [CrossRef] [Green Version]
- Heim, G.; Thuestad, R.O.; Molin, M.; Brevik, A. Free School Meal Improves Educational Health and the Learning Environment in a Small Municipality in Norway. Nutrients 2022, 14, 2989. [Google Scholar] [CrossRef]
- Illøkken, K.E.; Johannessen, B.; Barker, M.E.; Hardy-Johnson, P.; Øverby, N.C.; Vik, F.N. Free school meals as an opportunity to target social equality, healthy eating, and school functioning: Experiences from students and teachers in Norway. Food Nutr. Res. 2021, 65. [Google Scholar] [CrossRef]
- Maynard, M.; Gunnell, D.; Ness, A.; Abraham, L.; Bates, C.J.; Blane, D. What influences diet in early old age? Prospective and cross-sectional analyses of the Boyd Orr cohort. Eur. J. Public Health 2006, 16, 315–323. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bjelland, M.; Brantsæter, A.L.; Haugen, M.; Meltzer, H.M.; Nystad, W.; Andersen, L.F. Changes and tracking of fruit, vegetables and sugar-sweetened beverages intake from 18 months to 7 years in the Norwegian mother and child cohort study. BMC Public Health 2013, 13, 793. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hovdenak, I.M.; Stea, T.H.; Twisk, J.; Te Velde, S.J.; Klepp, K.I.; Bere, E. Tracking of fruit, vegetables and unhealthy snacks consumption from childhood to adulthood (15 year period): Does exposure to a free school fruit programme modify the observed tracking? Int. J. Behav. Nutr. Phys. Act. 2019, 16, 22. [Google Scholar] [CrossRef] [Green Version]
- Norwegian Institute of Public Health. Sykdomsbyrde i Norge 1990–2013. Resultater fra Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013); Norwegian Institute of Public Health: Trondheim, Norway, 2016.
- Norwegian Directorate of Health. Anbefalinger om Kosthold, Ernæring og FYSISK Aktivitet; Norwegian Directorate of Health: Oslo, Norway, 2014.
- Hansen, L.; Myhre, J.; Andersen, L. UNGKOST 3 Landsomfattende Kostholdsundersøkelse Blant 4-åringer i Norge, 2016; Helsedirektoratet, Mattilsynet og Universitetet i Oslo: Oslo, Norway, 2017. [Google Scholar]
- Western, I.M.; Skårdal, M.; Ask, A.; Øverby, N.C. Dietary habits and behaviour problems at school among Norwegian 14 year olds. J. Int. Soc. Teach. Educ. 2017, 21, 77–87. [Google Scholar]
- Norwegian Ministry of Health Care Services. National Strategy to Reduce Social Inequalities in Health; Norwegian Ministry of Health and Care Services: Oslo, Norway, 2006.
- Norwegian Directorate of Health. Gradientutfordringen: Sosial- og Helsedirektoratets Handlingsplan Mot Sosiale Ulikheter i Helse; Norwegian Directorate of Health: Oslo, Norway, 2005. [Google Scholar]
- Ministry of Health and Care Services. Report No. 16 to the Storting (2002–2003)—Prescriptions for a Healthier Norway; Helsedepartementet: Oslo, Norway, 2002.
- Ministry of Education and Research. Early Intervention for Lifelong Learning; Ministry of Education and Research: Oslo, Norway, 2006.
- Bere, E.; Hilsen, M.; Klepp, K.-I. Effect of the nationwide free school fruit scheme in Norway. Br. J. Nutr. 2010, 104, 589–594. [Google Scholar] [CrossRef]
- Bere, E.; Veierød, M.B.; Klepp, K.-I. The Norwegian School Fruit Programme: Evaluating paid vs. no-cost subscriptions. Prev. Med. 2005, 41, 463–470. [Google Scholar] [CrossRef] [PubMed]
- Øverby, N.C.; Klepp, K.-I.; Bere, E. Introduction of a school fruit program is associated with reduced frequency of consumption of unhealthy snacks. Am. J. Clin. Nutr. 2012, 96, 1100–1103. [Google Scholar] [CrossRef] [Green Version]
- Ministry of Education and Research. Endringer i Opplæringslova, Privatskolelova og Folkehøyskoleloven (leksehjelp m.m.); Ministry of Education and Research: Oslo, Norway, 2014.
- Craig, P.; Gibson, M.; Campbell, M.; Popham, F.; Katikireddi, S.V. Making the most of natural experiments: What can studies of the withdrawal of public health interventions offer? Prev. Med. 2018, 108, 17–22. [Google Scholar] [CrossRef]
- Bere, E. Increasing Schoolchildren’s Intake of Fruit and Vegetables: Fruits and Vegetables Make the Marks; Universitetet i Oslo: Oslo, Norway, 2004. [Google Scholar]
- Andersen, L.F.; Bere, E.; Kolbjornsen, N.; Klepp, K.-I. Validity and reproducibility of self-reported intake of fruit and vegetable among 6th graders. Eur. J. Clin. Nutr. 2004, 58, 771–777. [Google Scholar] [CrossRef] [Green Version]
- Dalane, J.Ø.; Bergvatn, T.A.M.; Kielland, E.; Carlsen, M.H. Weights, Measures and Portion Sizes for Foods; Report No.: IS-2286; Mattilsynet, Universitetet i Oslo og Helsedirektoratet: Oslo, Norway, February 2015. [Google Scholar]
- Bere, E.; Klepp, K.-I. Correlates of fruit and vegetable intake among Norwegian schoolchildren: Parental and self-reports. Public Health Nutr. 2004, 7, 991–998. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ransley, J.K.; Greenwood, D.C.; Cade, J.E.; Blenkinsop, S.; Schagen, I.; Teeman, D.; Scott, E.; White, G.; Schagen, S. Does the school fruit and vegetable scheme improve children’s diet? A non-randomised controlled trial. J. Epidemiol. Community Health 2007, 61, 699–703. [Google Scholar] [CrossRef] [Green Version]
- Rasmussen, M.; Krølner, R.; Klepp, K.-I.; Lytle, L.; Brug, J.; Bere, E.; Due, P. Determinants of fruit and vegetable consumption among children and adolescents: A review of the literature. Part I: Quantitative studies. Int. J. Behav. Nutr. Phys. Act. 2006, 3, 22. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vejrup, K.; Lien, N.; Klepp, K.-I.; Bere, E. Consumption of vegetables at dinner in a cohort of Norwegian adolescents. Appetite 2008, 51, 90–96. [Google Scholar] [CrossRef]
- Bere, E.; Klepp, K.-I. Changes in accessibility and preferences predict children’s future fruit and vegetable intake. Int. J. Behav. Nutr. Phys. Act. 2005, 2, 15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tak, N.I.; Velde, S.J.T.; Singh, A.S.; Brug, J. The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid-morning school breaks: Results of the Dutch Schoolgruiten Project. J. Hum. Nutr. Diet. 2010, 23, 609–615. [Google Scholar] [CrossRef]
- Te Velde, S.J.; Brug, J.; Wind, M.; Hildonen, C.; Bjelland, M.; Perez-Rodrigo, C.; Klepp, K.I. Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: The Pro Children Study. Br. J. Nutr. 2008, 99, 893–903. [Google Scholar] [CrossRef] [Green Version]
- Fogarty, A.W.; Antoniak, M.; Venn, A.J.; Davies, L.; Goodwin, A.; Salfield, N.; Stocks, J.; Britton, J.; Lewis, S.A. Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children? Int. J. Epidemiol. 2007, 36, 1080–1085. [Google Scholar] [CrossRef] [Green Version]
- Bere, E.; Veierød, M.B.; Skare, Ø.; Klepp, K.-I. Free school fruit–sustained effect three years later. Int. J. Behav. Nutr. Phys. Act. 2007, 4, 5. [Google Scholar] [CrossRef] [Green Version]
- Craig, P.; Cooper, C.; Gunnell, D.; Haw, S.; Lawson, K.; Macintyre, S.; Ogilvie, D.; Petticrew, M.; Reeves, B.; Sutton, M.; et al. Using natural experiments to evaluate population health interventions: New Medical Research Council guidance. J. Epidemiol. Community Health 2012, 66, 1182–1186. [Google Scholar] [CrossRef] [Green Version]
- Evans, C.E.; Christian, M.S.; Cleghorn, C.L.; Greenwood, D.C.; Cade, J.E. Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y. Am. J. Clin. Nutr. 2012, 96, 889–901. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wind, M.; de Bourdeaudhuij, I.; Velde, S.J.T.; Sandvik, C.; Due, P.; Klepp, K.-I.; Brug, J. Correlates of Fruit and Vegetable Consumption Among 11-Year-Old Belgian-Flemish and Dutch Schoolchildren. J. Nutr. Educ. Behav. 2006, 38, 211–221. [Google Scholar] [CrossRef] [PubMed]
- Roccaldo, R.; Censi, L.; D’Addezio, L.; Canani, S.B.; Gennaro, L. A teachers’ training program accompanying the “School Fruit Scheme” fruit distribution improves children’s adherence to the Mediterranean diet: An Italian trial. Int. J. Food Sci. Nutr. 2017, 68, 887–900. [Google Scholar] [CrossRef] [PubMed]
2001 | 2008 | 2018 | p Value 1 01–08 | p Value 1 08–18 | |
---|---|---|---|---|---|
All | |||||
Number of schools | 38 | 27 | 25 | ||
Eligible pupils | 2287 | 1712 | 1734 | ||
Participating pupils | 1950 | 1339 | 760 | ||
Participation rate (%) | 85 | 78 | 44 | ||
Sample | |||||
Number of schools | 18 | 18 | 18 | ||
Pupil data | |||||
Participating pupils | 963 | 911 | 561 | ||
Sex, female (%) | 49 | 52 | 53 | 0.258 | 0.064 |
Age, seventh graders (%) | 48 | 49 | 53 | 0.777 | 0.094 |
FV intake all day (portions/d) 2 | 2.4 (±2.33) | 3.2 (±2.8) | 2.6 (±2.1) | <0.001 * | <0.001 * |
FV intake at school (portions/d) 2 | 0.4 (±0.6) | 0.8 (±0.9) | 0.7 (±0.7) | <0.001 * | 0.245 |
Eating FV 4–5 d/week at school (%) | 28 | 65 | 56 | <0.001 * | 0.002 * |
Unhealthy snacks (times/week) 2 | 6.9 (±4.3) | 4.6 (±3.3) | 4.3 (±2.8) | <0.001 * | 0.016 * |
Parent data | |||||
Participating parents | 809 | 668 | 431 | ||
Participation rate (%) | 84 | 73 | 77 | ||
Sex, female (%) | 85 | 79 | 79 | 0.006 * | 0.988 |
Age (mean, years) 2 | 40.1 (±5.8) | 40.9 (±5.1) | 42.7 (±5.5) | 0.004 * | <0.001 * |
Higher education (%) | 43 | 55 | 69 | <0.001 * | <0.001 * |
2008 | 2018 | Change 08–18 | p for Time × Group Interaction 1 | |||
---|---|---|---|---|---|---|
Mean | 95% CI | Mean | 95% CI | |||
At school | ||||||
FV (portions/d) | 0.173 | |||||
Intervention | 0.82 | 0.57–1.06 | 0.53 | 0.22–0.85 | −0.29 | |
Control | 0.77 | 0.64–0.89 | 0.72 | 0.58–0.85 | −0.05 | |
Fruit (portion/d) | 0.047 | |||||
Intervention | 0.66 | 0.49–0.84 | 0.40 | 0.15–0.64 | −0.27 | |
Control | 0.51 | 0.42–0.60 | 0.52 | 0.42–0.62 | 0.01 | |
Vegetables (portions/d) | 0.619 | |||||
Intervention | 0.16 | 0.03–0.28 | 0.14 | −0.03–0.31 | −0.02 | |
Control | 0.26 | 0.19–0.32 | 0.20 | 0.12–0.27 | −0.06 | |
All day | ||||||
FV (portions/d) | 0.270 | |||||
Intervention | 3.26 | 2.54–3.98 | 2.19 | 1.25–3.12 | −1,07 | |
Control | 3.18 | 2.79–3.56 | 2.63 | 2.21–3.04 | −0.55 | |
Fruit (portion/d) | 0.128 | |||||
Intervention | 2.09 | 1.71–2.47 | 1.21 | 0.64–1.77 | −0.88 | |
Control | 1.97 | 1.77–2.17 | 1.60 | 1.37–1.82 | −0.37 | |
Vegetables (portions/d) | 0.902 | |||||
Intervention | 1.18 | 0.80–1.59 | 0.99 | 0.46–1.52 | −0.19 | |
Control | 1.19 | 0.97–1.41 | 1.03 | 0.80–1.27 | −0.16 | |
FFQ 4-5 times/week | <0.001 | |||||
Intervention (% yes) | 85 | 70–100 | 50 | 32–69 | −35 | |
Control (% yes) | 61 | 53–69 | 59 | 50–68 | −2 | |
Unhealthy snacks | ||||||
Intervention (times/week) | 3.67 | 3.16–4.18 | 4.54 | 3.69–5.38 | 0.87 | 0.012 |
Control (times/week) | 4.67 | 4.35–4.88 | 4.17 | 3.85–4.49 | −0.50 |
2001 | 2008 | 2018 | Change 2001–08 p.p. | Change 2008–18 p.p. | |||||
---|---|---|---|---|---|---|---|---|---|
N | Percentage | 95% CI | Percentage | 95% CI | Percentage | 95% CI | |||
Intervention | |||||||||
Boys | 191 | 15 | 6–23 | 79 | 70–88 | 38 | 22–54 | 64 | −41 |
Girls | 66 | 44 | 31–56 | 91 | 85–97 | 55 | 37–72 | 47 | −36 |
Low parental education | 44 | 31 | 20–43 | 80 | 69–91 | 57 | 27–87 | 48 | −23 |
High parental education | 140 | 30 | 12–42 | 91 | 85–98 | 41 | 24–59 | 62 | −50 |
Control | |||||||||
Boys | 574 | 23 | 18–28 | 52 | 46–58 | 53 | 45–60 | 29 | 1 |
Girls | 414 | 33 | 28–38 | 65 | 59–70 | 62 | 56–68 | 32 | −3 |
Low parental education | 307 | 29 | 24–34 | 55 | 49–62 | 57 | 48–67 | 27 | 2 |
High parental education | 475 | 30 | 24–36 | 66 | 59–72 | 62 | 56–68 | 36 | 4 |
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Richardsen, H.K.; Bere, E.T.; Stea, T.H.; Klepp, K.-I.; Engeset, D. Effect of Ending the Nationwide Free School Fruit Scheme on the Intake of Fruits, Vegetables, and Unhealthy Snacks in Norwegian School Children Aged 10–12 Years. Int. J. Environ. Res. Public Health 2023, 20, 2489. https://doi.org/10.3390/ijerph20032489
Richardsen HK, Bere ET, Stea TH, Klepp K-I, Engeset D. Effect of Ending the Nationwide Free School Fruit Scheme on the Intake of Fruits, Vegetables, and Unhealthy Snacks in Norwegian School Children Aged 10–12 Years. International Journal of Environmental Research and Public Health. 2023; 20(3):2489. https://doi.org/10.3390/ijerph20032489
Chicago/Turabian StyleRichardsen, Helene Kristin, Elling Tufte Bere, Tonje Holte Stea, Knut-Inge Klepp, and Dagrun Engeset. 2023. "Effect of Ending the Nationwide Free School Fruit Scheme on the Intake of Fruits, Vegetables, and Unhealthy Snacks in Norwegian School Children Aged 10–12 Years" International Journal of Environmental Research and Public Health 20, no. 3: 2489. https://doi.org/10.3390/ijerph20032489