Regular articleCorrelates of fruit and vegetable intake among adolescents: Findings from Project EAT
Introduction
Numerous health benefits have been found to be associated with a diet that is abundant in fruits and vegetables. There is strong epidemiological evidence of a protective role for fruits and vegetables in the prevention of cancer [1], [2] and coronary heart disease [3], [4]. In addition, evidence is emerging that supports a role for fruits and vegetables in preventing stroke, cataract formation, chronic obstructive pulmonary disease, diverticulosis, and possibly hypertension [1]. In light of these benefits, fruit and vegetable intake has been targeted in Healthy People 2010, a comprehensive, nationwide health promotion and disease prevention agenda [5].
Eating a diet rich in fruits and vegetables may be particularly important during adolescence due to the high nutrient needs during this rapid period of growth and development [6]. Furthermore, the development of healthy eating patterns during adolescence, including an adequate fruit and vegetable intake, may lead to continued healthy eating patterns during adulthood [7]. In spite of the importance of an adequate intake of fruits and vegetables during adolescence, several studies have found that adolescents have intakes well below the recommended amounts [8], [9], [10], [11], [12], [13]. In Project EAT (Eating Among Teens), a large population-based study of eating patterns among adolescents in Minnesota, fruit/vegetable intake was considerably lower than the Healthy People 2010 recommendations [5], [14]. Only 45% of adolescents reported eating the recommended two or more daily servings of fruit (Healthy People 2010 target: 75%). Approximately 17% of adolescents reported eating three or more daily servings of vegetables, with slightly lower percentages (12%) reporting three or more servings of vegetables, of which at least one was deep yellow/green. Less than one-third of the adolescents (31%) ate five or more daily servings of fruits or vegetables.
To develop effective interventions to increase fruit/vegetable intake, an understanding of etiological processes and the identification of potentially modifiable correlates is needed. Few studies have examined correlates of fruit/vegetable intake among adolescents, and most of this work has been limited by a lack of a strong theoretical framework and inadequate measures of fruit/vegetable intake or potential correlates of intake [9], [15], [16], [17]. Factors that have been found to be correlated with higher fruit and vegetable intake in previous studies of adolescents, or have been identified by adolescents who participated in focus groups as factors influencing their fruit and vegetable intake, include taste preferences for fruit and vegetables, parental intake, peer influences, self-efficacy to eat fruits and vegetables, availability of fruits and vegetables, and higher socio-economic status [9], [10], [11], [13], [18], [19], [20], [21]. A statewide population-based study of adolescents found that inadequate fruit/vegetable intake was part of a larger cluster of adolescent health issues including weight dissatisfaction, dieting (for fruit intake only), binge eating, substance abuse, past suicide attempts, lower academic achievement, and low family connectedness [9]. There has been more theory-based research among children [22], [23], [24], [25], [26], [27], [28]. Much of this theory-based research has been grounded in social cognitive theory [29], [30], which emphasizes the importance of factors from within the socio-environmental, personal, and behavioral domains and their interactions with each other. Taste preferences [23], [25], [27] and availability [26], [27], [31] have been identified as two of the strongest and most consistent correlates of fruit and vegetable intake in children and adolescents.
This study expands upon the existing body of literature that explores factors associated with fruit/vegetable intake among adolescents by (1) testing a comprehensive model based on a theoretical framework and empirical data collected from adolescents on perceived factors influencing their food choices (2) having a large and diverse study population in terms of ethnicity and socio-economic backgrounds; and (3) utilizing a comprehensive food frequency questionnaire that was designed for youth to assess fruits and vegetable intake. Social cognitive theory (SCT) [29], [30], findings from previous studies on correlates of fruits and vegetables [9], [15], [16], [17], and data collected from youth in focus group discussions [18] guided the selection of variables included as potential correlates of fruit and vegetable intake. The primary study objective was to test a comprehensive model, grounded in SCT and empirical data, to explain fruit/vegetable intake among adolescents and identify specific correlates of intake. It was hypothesized that fruit and vegetable intake would be explained by a combination of personal factors (taste preferences for fruits/vegetables, health/nutrition attitudes, weight/body concerns, and self-efficacy to make healthy food choices), behavioral factors (meal frequency, fast food intake, and unhealthy weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). Secondary study objectives were to identify factors associated with home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between home availability of fruits/vegetables and taste preferences for fruits/vegetables.
Section snippets
Study population
The overall study population included 4746 adolescents from 31 public middle schools and high schools from urban and suburban school districts in the St. Paul/Minneapolis area of Minnesota. School districts serving ethnically and socio-economically diverse populations were selected for inclusion in the study. From within these school districts, schools not participating in other related studies were invited to participate. Participants were equally divided by gender (50.2% boys, 49.8% girls).
Measurement model
Table 2 shows the resulting factor loadings and simple correlation of each factor with fruit/vegetable intake obtained from the confirmatory factor analysis on the full data set (i.e., 3957 adolescents). All factor loadings are significant at the 0.01 level and have magnitude greater than or equal to 0.30. Despite the significant chi-square test, other model testing statistics suggest that the measurement model fits the data well (χ2 = 3099, df = 347, P < 0.001; 90% RMSEA confidence interval =
Discussion
This study explored factors associated with fruit and vegetable intake among adolescents. The main variables found to be directly associated with fruit/vegetable intake included home availability and taste preferences, suggesting the importance of addressing these variables in interventions. It appears to be particularly important to address home availability of fruits/vegetables in light of its stronger association with fruit/vegetable intake, its assumed role in influencing taste preferences,
Acknowledgements
This study was supported by grant MCJ-270834 (D. Neumark-Sztainer, principal investigator) from the Maternal and Child Health Bureau (Title V. Social Security Act), Health Resources and Service Administration, U.S. Department of Health and Human Services. The authors would like to acknowledge students and staff from the St. Paul, Minneapolis, and Osseo, Minnesota, school districts for participating in this study.
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2023, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :The two items were summed for total daily parent fruit and vegetable intake (measured in cups). Times fast food was consumed in the past week was measured with a single survey item used in previous research.29,30 The item was: “In the past SEVEN DAYS, how often did YOU eat something from a fast food restaurant, such as McDonald's, Burger King, Hardee's, Domino's or similar places? (