BACKGROUND Interventions designed to encourage fruit and vegetable (F/V) consumption within schools are increasingly common. Thus, there is a need for valid, practical dietary assessment instruments to evaluate their effectiveness. OBJECTIVE The aim of this study was to examine the validity of a group-administered, paper-and-pencil questionnaire to assess F/V selection and consumption at school lunch relative to digital photography. DESIGN This was a five-phase, method-comparison study in which the questionnaire was iteratively modified between each phase. PARTICIPANTS/SETTING The study examined sets of questionnaires and photographs of lunch trays (n=1,213) collected on 44 days between May 2015 and June 2016 among second-grade students from three New York City schools (phases 1 to 4) and second- and third-grade students from 20 schools across eight states (phase 5). MAIN OUTCOME MEASURES Outcomes assessed were selection, amount eaten, preference, and intention to consume F/V. STATISTICAL ANALYSES PERFORMED Validity was assessed by percent agreement (categorized as "match, omission, or intrusion" for items on or off tray and "match, overestimation, or underestimation" for amount eaten), Spearman correlation coefficients, and intraclass correlation coefficients (ICC). RESULTS The total match rate for items on tray was substantial (phases 1 to 5: 83%, 84%, 92%, 93%, and 89%), with items more frequently intruded than omitted. For amounts eaten, the total match rates were moderate, but generally improved throughout the study (phases 1 to 5: 65%, 64%, 83%, 83%, and 76%), with overestimations more frequent than underestimations. There was good correspondence between methods in the estimates of amount eaten in a quantitative, cup equivalent amount (fruit ICC=0.61; vegetables ICC=0.64). Significant differences (α=.05) were not observed between second- and third-grade students, respectively, in the match rate for fruits (86% and 89%) or vegetable (89% and 86%) items on tray or fruit (69% and 73%) and vegetables (74% and 76%) amount eaten. Excellent correlations were observed between amount eaten and preference for fruit (r=0.91) and vegetables (r=0.93). CONCLUSIONS The questionnaire offers a feasible, valid instrument for assessing F/V selection and consumption among elementary students in schools participating in the National School Lunch Program. Additional research is recommended to test the instrument's sensitivity and to reproduce these findings using an alternative reference method, such as direct observations.

中文翻译：

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测量二、三年级学生在学校午餐时选择和食用的水果和蔬菜的问卷的验证

背景 旨在鼓励学校内水果和蔬菜 (F/V) 消费的干预措施越来越普遍。因此，需要有效、实用的膳食评估工具来评估其有效性。目的 本研究的目的是检查小组管理的纸笔问卷的有效性，以评估与数码摄影相关的学校午餐的 F/V 选择和消耗。设计 这是一项五阶段的方法比较研究，其中问卷在每个阶段之间反复修改。参与者/设置 该研究检查了一组问卷和午餐托盘的照片（n = 1，213) 在 2015 年 5 月至 2016 年 6 月期间的 44 天里，在来自纽约市三所学校（第 1 至第 4 阶段）的二年级学生和来自八个州（第 5 阶段）的 20 所学校的二年级和三年级学生中收集。主要结果测量 评估的结果包括选择、食用量、偏好和食用 F/V 的意图。执行的统计分析 有效性通过百分比一致性（对托盘上或托盘外的物品分类为“匹配、遗漏或侵入”以及对食用量分类为“匹配、高估或低估”）、Spearman 相关系数和类内相关系数（ICC ）。结果 托盘上物品的总匹配率很高（第 1 至第 5 阶段：83%、84%、92%、93% 和 89%），物品被干扰的频率高于遗漏的频率。对于食用量，总匹配率适中，但在整个研究过程中总体上有所改善（第 1 至第 5 阶段：65%、64%、83%、83% 和 76%），高估比低估更频繁。以定量、杯等量（水果 ICC=0.61；蔬菜 ICC=0.64）估计食用量的方法之间存在良好的对应关系。二年级和三年级学生在水果（86% 和 89%）或蔬菜（89% 和 86%）托盘或水果的匹配率方面分别未观察到显着差异 (α=.05)。 69% 和 73%）和蔬菜（74% 和 76%）的食用量。在食用量与对水果 (r=0.91) 和蔬菜 (r=0.93) 的偏好之间观察到极好的相关性。结论 该问卷提供了一个可行的、评估参加国家学校午餐计划的学校小学生的 F/V 选择和消费的有效工具。建议进行更多研究以测试仪器的灵敏度并使用替代参考方法（例如直接观察）重现这些发现。