BACKGROUND Consumption of fruits and vegetables (F/V) among elementary school-aged children remains inadequate, especially among low-income children. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks to children during the school day, outside of school meals. School-based initiatives are successful in changing behaviors in school settings; however, their influence on behaviors outside of schools needs investigation. OBJECTIVE To examine whether FFVP participation is associated with F/V requests at stores, self-efficacy to ask for and choose F/V at home, and F/V consumption. DESIGN Cross-sectional study. PARTICIPANT/SETTING Fourth graders in six classrooms (n=296) from three urban, low-income school districts in Phoenix, AZ, were surveyed during 2015; one FFVP and one non-FFVP school from each district that were similar in school size, percent free/reduced-price meal eligibility, and race/ethnicity of enrolled students were selected. MAIN OUTCOME MEASURES Children's self-reported F/V requests during shopping, their self-efficacy to ask for and choose F/V at home, and F/V consumption on the previous day (non-FFVP school day) were measured using questions adapted from validated surveys. STATISTICAL ANALYSIS Multivariable mixed-effect regression models, adjusting for clustering of students within classes and classes within schools were explored. RESULTS In models adjusting for individual-level factors (ie, age and sex) only, several significant positive associations were observed between school FFVP participation and healthier F/V outcomes. After additionally adjusting for school-level factors (ie, total enrollment and % Hispanic/Latino students) significant associations were observed between school FFVP participation and more requests for vegetables during shopping (P<0.001), higher scores on self-efficacy to choose vegetables at home (P=0.004), stronger preferences for vegetables (P<0.001), and more frequent consumption of fruit (P=0.006). CONCLUSIONS School FFVP participation was associated with more requests for vegetables during shopping and higher self-efficacy to make healthy choices at home, suggesting the influence of the FFVP may extend beyond the school day.

中文翻译：

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新鲜水果和蔬菜计划以及校外水果和蔬菜的要求

背景 小学生尤其是低收入儿童的水果和蔬菜（F/V）消费量仍然不足。美国农业部的新鲜水果和蔬菜计划 (FFVP) 在上学期间，在学校用餐之外为儿童提供 F/V 作为零食。以学校为基础的举措成功地改变了学校环境中的行为；然而，他们对校外行为的影响需要调查。目的 考察 FFVP 参与是否与在商店的 F/V 请求、在家请求和选择 F/V 的自我效能以及 F/V 消费相关。设计横断面研究。参与者/环境 来自亚利桑那州凤凰城三个城市低收入学区的 6 个教室 (n=296) 的四年级学生在 2015 年接受了调查；选择了来自每个地区的一所 FFVP 学校和一所非 FFVP 学校，它们在学校规模、免费/减价餐资格百分比和注册学生的种族/民族方面都相似。主要观察指标 使用改编的问题测量儿童在购物期间自我报告的 F/V 请求、他们在家里要求和选择 F/V 的自我效能以及前一天（非 FFVP 上学日）的 F/V 消耗量来自经过验证的调查。统计分析 探索了多变量混合效应回归模型，调整班内学生和学校班级的聚类。结果 在仅调整个人层面因素（即年龄和性别）的模型中，在学校 FFVP 参与和更健康的 F/V 结果之间观察到了几个显着的正相关。在对学校层面的因素（即总入学人数和西班牙裔/拉丁裔学生的百分比）进行额外调整后，观察到学校 FFVP 参与与购物期间对蔬菜的更多要求之间存在显着关联（P<0.001），选择蔬菜的自我效能得分较高在家（P=0.004），更偏爱蔬菜（P<0.001），更频繁地食用水果（P=0.006）。结论 学校 FFVP 参与与购物期间对蔬菜的更多要求和在家做出健康选择的更高自我效能感相关，这表明 FFVP 的影响可能会延伸到上课日以外。在家选择蔬菜的自我效能感得分较高（P=0.004），对蔬菜的偏好更强（P<0.001），以及更频繁地食用水果（P=0.006）。结论 学校 FFVP 参与与购物期间对蔬菜的更多要求和在家做出健康选择的更高自我效能感相关，这表明 FFVP 的影响可能会延伸到上课日以外。在家选择蔬菜的自我效能感得分较高（P=0.004），对蔬菜的偏好更强（P<0.001），以及更频繁地食用水果（P=0.006）。结论 学校 FFVP 参与与购物期间对蔬菜的更多要求和在家做出健康选择的更高自我效能感相关，这表明 FFVP 的影响可能会延伸到上课日以外。