Fresh Produce Delivery to Middle School Youth: Outcomes of a Case Study in Providing Fresh Fruit and Vegetables to Underserved Youth

Abstract

Purpose

The purpose of this study was to evaluate a weekly school-based fruit and vegetable delivery via a mobile market on urban middle schoolers’ nutrition behaviors.

Design

One-group, pretest-posttest design, quasi-experimental intervention in middle schoolers (6th-8th graders, N = 158) in Kansas City, MO

Intervention

Weekly delivery of free produce via a mobile market over 12 weeks.

Measures

A self-administered survey to assess self-report consumption of fruits, vegetables, soda, and sports drinks.

Analysis

Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were conducted to compare youth at baseline and 12 weeks.

Results

More youth reported consuming fresh fruit (73.8% to 83.3%; χ² = 7.76, P = .005) and vegetables (66.4% to 71.3%; χ² = 13.55, P = <.001) from baseline to follow-up. Less youth reported soda (49.0% to 52.8%; χ²= 6.33, P = .012) and sports drinks (41.8% to 38.2%; χ²= 12.32, P < .001) from baseline to follow-up.

Conclusions

A mobile produce delivery intervention, like the Healthy Harvest Mobile Market, may be an effective strategy to increase fruit and vegetable consumption for adolescents.

Keywords

adolescents nutrition fruit and vegetable consumption

Purpose

In the United States, 35.4% of adolescents are overweight or obese.¹ Racial minority and socioeconomically disadvantaged youth are at an elevated risk of being overweight or obese.¹ Diet is one contributing factor to the high rates of childhood obesity.

Fruit and vegetable consumption is integral to preventing obesity and promoting growth during adolescence.² However, fewer than 10% of adolescents meet the U.S. Department of Agriculture recommendations of 2.5 cups of vegetables and 2 cups of fruit per day.³ Similar to obesity rates, racial/ethnic disparities exist particularly for vegetable consumption.¹

Determinants of fruit and vegetable consumption for adolescents include availability, age, socio-economic position, parent dietary behaviors, preferences and gender.⁴ School-based, multi-component interventions including fruit and vegetable subscription service, gardening, school and club curriculum, and family-based, and health education via technology show promising results to increase consumption of fruits and vegetables within adolescents.^5-7

Availability of fruit and vegetables is a strong predictor of fruit and vegetable consumption.⁸ However, food deserts are common in urban and low-income communities, limiting one’s access to healthy and affordable food.⁹ Food deserts are “low-income census tracts with low access to healthy food, meaning residence more than 1 mile away form a grocery store or supermarket in urban areas (or 10-20 miles in rural areas).”¹⁰ Effective strategies to increase access to fruits and vegetables includes mobile markets,¹¹ community-supported agriculture,¹² and meal preparation kits.¹³ However, to our knowledge, these strategies have not been tailored, implemented, nor studied among adolescent populations.

Therefore, the purpose of this study is to evaluate the outcomes of a school-based intervention that delivers fresh produce weekly to middle schoolers via a mobile market.

Methods

Design

This study is a 12-week, single group, pretest-posttest design starting in August 2021 among middle schoolers from the Kansas City Public School District (KCPS). Parents/guardians and youth provided informed consent and assent. All study procedures were approved by the University of Missouri-Kansas City Institutional Review Board, protocol 2017528.

Sample

All students from three schools were eligible to participate in after school activities, including receiving free produce. KCPS predominantly serves racial and ethnic minority, low-income (99.8% free or reduced lunch), inner-city youth.¹⁴ Students were recruited initially to participate in the intervention at school enrollment events, parent/teacher conferences, at lunch-time, and by teachers and staff.

Measures

The study used self-administrated questionnaire to assess self-reported demographics (grade level, gender, and race/ethnicity) and whether the participant consumed fruits, vegetables, soda, or sports drinks the prior day, using questions adapted from the 2019 Youth Risk Behavior Survey High School instrument.¹⁵ Participants could respond yes, no, or not sure to each question. Not sure responses were excluded from the analysis. The outcomes variables for consumption of fruits, vegetables, soda, and sports drinks were dichotomous (yes/no). Pre-test and post-test data were collected after school but before the intervention started. Participants who attended during the intervention completed surveys. Only those students who participated in the baseline data collected were allowed to participate in the follow-up data collection.

Intervention

Move More Get More (MMGM) was designed using formative research¹⁶ to improve physical activity and nutrition behaviors in middle schoolers. Afterschool programming included sport sampling sessions and weekly bags of fruits and vegetables that were provided free by the Healthy Harvest Mobile Market (HHMM), within Community Health Strategies and Innovation of University Health.¹⁷ Produce was provided at the end of all activities to take home. Produce was not consumed at the school. All students in the afterschool program received free produce.

Weekly, HHMM delivers free produce to participants of MMGM at each middle school including a rotating assortment of 6-8 different fresh fruits and vegetables, worth approximately $20, accompanied by nutrition literacy materials and recipes.

Analysis

Means, standard deviation, and frequencies were calculated for all study variables. Univariate and bivariate analyses were used. Proportions were compared and chi-square tests were used to compare youth surveyed at baseline and responses at 12-week follow-up for all study variables. All analyses were conducted in IBM SPSS 26 (N.Y., USA).

Results

A total of 910 bags of produce were delivered to youth over the 12-week intervention. Table 1 presents the demographics of the sample. At baseline (N =154), youth reported being in 6^th (30.5%), 7^th (29.9%), and 8^th (39.6%) grades. The sample was majority male (54.9%) and Black (62.2%). At follow-up (N = 98), participating youth reported being in 6^th (32.7%), 7^th (35.7%), and 8^th (31.6%) grades. The follow-up sample was majority male (58.2%) and Black (56.0%). On average, youth received produce 4.71 times (SD: 3.05) over the 12 weeks.

Table 1.

Participant Demographics.

	Baseline n (%)	3 Month Follow-Up n (%)
Grade
6^th	47 (30.5)	32 (32.7)
7th	46 (29.9)	35 (35.7)
8th	61 (39.6)	31 (31.6)
Sex
Male	84 (54.9)	57 (58.2)
Female	63 (41.2)	37 (37.8)
Prefer not to say	6 (3.9)	4 (4.1)
Race^a
Black or African American	107 (62.2)	65 (56.0)
Hispanic or Latinx	33 (21.6)	19 (16.4)
Asian	4 (2.3)	6 (5.2)
Native Hawaiian or Pacific Islander	1 (.6)	1 (.9)
American Indian or Alaska Native	8 (4.7)	5 (4.3)
White	39 (22.7)	20 (17.2)

^aRespondents could select multiple racial groups. Therefore, the total does not sum to 100%.

*No statistical differences were found from baseline to follow-up on demographic variables.

Table 2 presents the proportion and chi-square difference tests for youth consuming fruit, vegetables, soda and sports drinks. Fruit and vegetable consumption significantly increased from baseline to follow-up: fruit (73.8% to 83.3%, χ² = 7.76, P = .005) vegetables (66.4% to 71.3%; χ² = 13.55, p = < .001). Soda consumption significantly increased (49.0% to 52.8%; χ² = 6.33, P = .012). Sports drink consumption significantly decreased (41.8% to 38.2%; χ² = 12.32, P < .001).

Table 2.

Yes Responses to Consumption the Prior Day; Baseline, 3-Month, Changes.

	Baseline n (%)	3 Month Follow-Up n (%)	Chi-Square
Fruit	107 (73.8%)	78 (83.3%)	7.76**
Vegetable	97 (66.4%)	62 (71.3%)	13.55***
Soda	70 (49.0%)	47 (52.8%)	6.33*
Sports drink	61 (41.8%)	34 (38.2%)	12.32***

*P ≤ .05, **P ≤ .01, ***P ≤ .001.

Discussion

Summary

A mobile produce delivery intervention, like the HHMM through MMGM, may be an important tool for public health advocates who aim to improve nutrition for adolescents. We found that the intervention significantly increased fruit and vegetable consumption after providing weekly produce deliveries for 12 weeks.

Nationally, racial and ethnic minorities consume less fresh produce than their White counterparts. In 2016, 12.7% of Black and 9.2% of Hispanic adolescents reported not consuming any vegetables in the last 7 days compared to 5.3% of White adolescents.³ Additionally, 7.0% of Black adolescents reported not consuming any fruit or 100% fruit juice in the last 7 days compared to 5.5% of White and 5.0% of Hispanic adolescents.³ Meeting fruit and vegetable consumption recommendations is an integral aspect of obesity prevention.² Previous studies show that mobile markets are effective strategies to combat food insecurity for adult populations.¹¹ The results of this study suggest that adolescents may benefit from similar interventions to increase access to fruits and vegetables as adults.

While no additional intervention material was provided to decrease consumption of sugary beverages, it was measured. Unlike previous research that suggested fruit distribution programs decrease soda intake,¹⁸ soda consumption significantly increased over the time in this intervention. One explanation may be that participants replaced sports drink consumption with soda consumption, seeing as sports drink consumption significantly decreased. Other studies have noted adolescents often replace one sugar-sweetened beverage for another.¹⁹

Limitations

This study must be viewed in the context of its limitations. We used a single group pre-test, post-test design without a control group. Retention was relatively low in this sample at 63.6%. Those youth who were not retained in the intervention may have diet-related behaviors that would alter our results. Attrition may have been due to changing schools due to family moving, disciplinary issues, and interest in other afterschool activities. Fruit and vegetable consumption were assessed using the YRBS self-report questionnaire and might be subjected to social desirability and reporting bias. The YRBS questionnaire, while widely used and validated for the study population, is limited and may not fully capture dietary behavior. Therefore, results could be due to attrition.

Significance

To our knowledge, this is the first study to evaluate the impacts of a mobile produce delivery on adolescent fruit and vegetable consumption. Produce delivery may have similar effects on adolescent nutrition as other nutrition interventions, such as health coaching and nutritional education.²⁰ We recruited a high proportion of racial/ethnic minority youth from schools that predominantly serve low-income communities of color for a 12-week intervention. While outcomes are focused on individual outcomes, the produce has the potential of an expanded reach to the participants’ family.

So What?

What is already known on this topic?

We know fruit and vegetable consumption is key to preventing obesity.² Fewer than 10% of adolescents meet USDA fruit and vegetable recommendations.³ Increasing access to fruit and vegetables is an effective strategy to increase fruit and vegetable consumption.⁸

What does this article add?

This is the first study to our knowledge that adapted a free produce delivery intervention via a mobile market to adolescent populations. Mobile market produce deliveries seem to be an effective strategy to increase fruit and vegetable consumption in racially diverse adolescents.

What are the implications for health promotion practice and research?

Simple, participant-centered interventions, like a free school-based produce delivery is a novel strategy to increase fruit and vegetable consumption in adolescence. Produce deliveries have traditionally targeted adult populations.

Footnotes

Author Contributions

Joseph S. Lightner: funding acquisition, conceptualization, formal analysis, investigation, methodology, supervision, validation, writing – original draft, writing – review and editing. Amanda Grimes: funding acquisition, conceptualization, investigation, methodology, supervision, validation, writing – review and editing, Janet Rhone: funding acquisition, data curation, writing – review and editing, Kael Martin: funding acquisition, data curation, writing – review and editing, Justin Moss: data curation, data curation, writing – review and editing, Bridget Wray: investigation, methodology, supervision, validation, writing – review and editing, Katlyn Eighmy: investigation, methodology, supervision, validation, writing – review and editing, Ella Valleroy: investigation, methodology, supervision, validation, writing – review and editing, Maya Baughn: investigation, methodology, supervision, validation, writing – review and editing

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the US Dept of Health and Human Services (1 ASTWH190088-01-00).

ORCID iDs

Joseph S Lightner

Amanda Grimes

Katlyn Eighmy

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