Children in the United States consume too few fruits and vegetables. Improving child nutrition, along with promoting physical activity and tobacco use prevention, are the most important primary prevention strategies for improving U.S. public health. The Farm-to-School Program aims to increase children’s exposure and consumption to local fresh fruits and vegetables. South Carolina established the Farm-to-School Program in 2011, offering grants to 52 schools to partner with a local farmer, farmers market, or food distributor; offer these foods in the school cafeteria; and start or revitalize a school garden. In addition to small grants, schools received training, technical assistance, and coordination support from regional coordinators. The program was funded by Affordable Care Act’s Communities Putting Prevention to Work funds. The purpose of this study was to examine the impact of the program on children’s consumption of fresh fruits and vegetables and the perceptions of parents of the effects of farm-to-school programs on their families’ food choices.
There were two main aspects of this study: 1) the photographic plate waste analysis and 2) parent focus groups. Schools with greater than 50 percent of the student population eligible for free or reduced-price lunch submitted applications for the Farm-to-School Program in April 2011. Fifty-two schools were selected for participation with funds available on July 1, 2011. These schools were randomly selected for participation in the study, and then matched with another school from the same district with a similar population to serve as a comparison. Specifically, schools were matched based on the following criteria: total student enrollment in a school district as well as the number of students eligible for free lunch, number eligible for reduced-price lunch, and percent of students who receive free and reduced-price lunch, within the same school district. Data collectors visited a total of 19 schools, 12 of which were intervention and matched control schools. During each lunch period, one data collector placed a numbered sticker on each student’s lunch tray. A second data collector took a picture of each lunch tray after the students made all of their lunch choices. Stickers were sequentially numbered. A third data collector then took a photograph of each plate at the end of the lunch period. All of the pictures were renamed to the corresponding school and numbered sticker. Each of the food choices were coded according to food group (that is, vegetable, fruit, or entrée). The pictures were used to determine if a student consumed a bite, one-quarter, one-half, three-quarters, or a whole portion of each food item. The food amounts for all school visits were recorded in Excel and the data were analyzed in Stata 12 software. Models were used to estimate the effect of the Farm-to-School Program on children’s fruit and vegetable consumption.
For the focus groups, parents in five schools with a Farm-to-School Program were invited to participate. Parents were asked to describe their understanding of the Farm-to-School Program in their school, their own and their children’s perceptions of the program, and how the school program has affected their children’s asking behaviors, willingness to try fresh fruits and vegetables, and introduction of new foods to the family. The focus groups were transcribed and then analyzed in NVivo v. 9 software based on emerging themes.
The Farm-to-School Program produced a statistically significant difference in the combined fruit and vegetable consumption between the intervention and control schools. Students in schools that participated in the Farm-to-School Program consumed a greater amount of vegetables than students in the comparison schools, but the difference was not statistically significant in controlled analysis. Children attending farm-to-school schools were significantly more likely to taste a vegetable than children in comparison schools. There was a statistically significant difference for vegetable consumption and schools with “offer policies” had a greater consumption of vegetables (0.38 vs. 0.27 servings) than schools with “serve policies”. Children attending farm-to-school schools consumed significantly less fruit than children in comparison schools. This finding was attenuated when controlling for whether the school offered a la carte snacks during lunch. There was a statistically significant relationship between a la carte items and fruit consumption. Children who did not eat an a la carte item consumed on average of 0.48 servings of fruit whereas children who did eat an a la carte item consumed 0.37 servings of fruit (p<0.0001).
In focus groups, parents talked about their understanding of the Farm-to-School Program in their school through direct and indirect sources. When parents talk about their perceptions of the Farm-to-School Program, they mentioned the benefits of eating locally grown produce and the benefits to the South Carolina farmers. Parents described children having better knowledge about where food comes because of the Farm-to-School Program. When some parents described the program, it was tied to a program champion or a teacher, cafeteria manager, or school administrator that led the program in the school.
For the schools that were able to fully implement the school garden component, parents shared their children’s gardening experience in a positive way. Parents reported that children’s asking behaviors at home have changed because of their exposure to the school garden and the program. Parents expressed interest in becoming more involved with the Farm-to-School Program. When talking about being more involved, they most often referenced volunteering in the school garden. Parents expressed they would like to see a greater reach of the program school-wide. Overall, parents agreed the Farm-to-School Program should not only continue in their child’s school, but should be expanded to reach more children, parents, and community members. In addition to focus groups, field notes and pictures of cafeterias were gathered to provide an environmental context and captured the influence of factors such as the preparation of fruits and vegetables, program champions, schools with multiple programs, and district-level factors.