Changes in vegetable and fruit consumption and awareness among US adults: Results of the 1991 and 1997 5 A Day for Better Health Program surveys

doi:10.1016/S0002-8223(02)90181-1

Journal of the American Dietetic Association

Volume 102, Issue 6, June 2002, Pages 809-817

https://doi.org/10.1016/S0002-8223(02)90181-1 Get rights and content

Abstract

Objective The purpose of this study is to assess population-based changes in vegetable and fruit consumption and psychosocial correlates.

Design Two nationally representative random digit dial surveys conducted in 1991 and 1997; respondents were queried regarding consumption of and attitudes and knowledge about vegetables and fruit.

Subjects/Setting Respondents were 2,755 and 2,544 adults (in 1991 and 1997, respectively) older than 18 years.

Statistical Analysis Performed Vegetable and fruit consumption and message awareness were measured using weighted-only and regression model-adjusted analyses to assess changes.

Results Mean vegetable and fruit consumption was significantly (P=.007) higher in 1997 than in 1991 using weighted-only analyses, but remained significant only for Hispanic (P=.03) and nonsmoker (P=.004) subgroups when adjusted for demographic shifts. Significantly higher percentages were found in the model-adjusted analyses for those consuming 5 or more daily servings (23.4% to 25.8%), message awareness (7.7% to 19.2%), and knowledge of the 5 A Day Program (2.0% to 17.8%).

Applications/Conclusions A significantly positive change in vegetable and fruit consumption occurred between 1991 and 1997 according to traditional methods of survey data analysis, but null findings resulted when the data were adjusted for demographic shifts. Nutrition professionals should continue targeting specific demographic subgroups with tailored interventions to move all Americans toward achievement of dietary guidelines for vegetable and fruit consumption. J Am Diet Assoc. 2002;102:809–817.

Section snippets

Design

Both the 5 A Day baseline and follow-up surveys were random digit dial (RDD) surveys, representative of the US adult population. The follow-up survey was designed to have 90% power to detect a difference between surveys in consumption of vegetables and fruit, including 100% juice (vegetable and fruit), of 0.25 servings per day.

Sample

The baseline survey (n=2,837) was conducted from Aug 10 to Sept 22, 1991, before the program launch. African-Americans and Latinos were oversampled (n=1,031) to provide

Results

Table 1 shows the distribution of the sample and of the population according to various demographics for 1991 and 1997. In the time between the two surveys, the proportion of whites in the population decreased slightly, while the proportion of Hispanics (includes Mexican, Puerto Rican, Cuban, and other Spanish background) increased. The proportion of smokers decreased from 28% to 21%. The proportion of those in lower income categories decreased, and those in the higher income category

Message Awareness

The percentage of respondents who were aware of the need to eat 5 or more daily servings of vegetables and fruit for good health was significantly higher in 1997 vs 1991. Whites, women, those more educated, and those in the older age groups showed the most awareness. These same general demographic groups also consumed more vegetables and fruit per day. These significant changes in awareness indicate that, through the first 6 years of the 5 A Day Program, the 5 A Day message has reached a large

Applications/Conclusions

■ In a media environment that is multilayered, with commercial and sometime contradictory messages about food and nutrition, the public's awareness of the simple, positive 5 A Day message was substantially higher in 1997 vs 1991, and could serve as a model for other nutrition and physical activity messages.

■ Nutrition counseling efforts specifically aimed at increasing vegetable and fruit consumption among targeted subgroups, particularly African-Americans, men, smokers, those less educated,

References (43)

K.A. Steinmetz et al.
Vegetables, fruit, and cancer preventiona review
J Am Diet Assoc.
(1996)
K.D. Reynolds et al.
Increasing the vegetable and fruit consumption of fourth-gradersresults from the high 5 project
Prev Med.
(2000)
S.A.A. Beresford et al.
Seattle 5 a Day worksite program to increase vegetable and fruit consumption
Prev Med.
(2001)
M.A.S. Van Duyn et al.
Use of the transtheoretical model of change to successfully predict vegetable and fruit consumption
J NutrEduc.
(1998)
A.F. Subar et al.
Improving food frequency questionnairesa qualitative approach using cognitive interviewing
J Am Diet Assoc.
(1995)
M.K. Hunt et al.
Comparison of dietary assessment measures in the Treatwell 5 A Day worksite study
J Am Diet Assoc.
(1998)
F.E. Thompson et al.
Evaluation of two brief instruments and a food frequency questionnaire to estimate daily number of servings of fruit and vegetables
Am J Clin Nutr.
(2000)
E.L. Gibson et al.
Vegetable and fruit consumption, nutritional knowledge and beliefs in mothers and children
Appetite.
(1998)
E. Trudeau et al.
Demographic and psychosocial predictors of vegetable and fruit intakes differimplications for dietary interventions
J Am Diet Assoc.
(1998)
L.A.G. Ries et al.
The annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer
Cancer.
(2000)

World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition and the Prevention of Cancer: A...

G. Block et al.

Fruits, vegetables, and cancer preventiona review of the epidemiological evidence

Nutr Cancer.

(1992)

K.A. Steinmetz

Potter JD Vegetable, fruit and cancer

I. Epidemiology. Cancer Causes Control.

(1991)

P. van’t Veer et al.

Fruits and vegetables in the prevention of cancer and cardiovascular disease

Public Health Nutr.

(2000)

D.T. Verhoeven et al.

Epidemiological studies on brassica vegetables and cancer risk

Cancer Epidemiol Biomarkers Prev.

(1996)

A. Schatzkin et al.

Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas

Polyp Prevention Trial Study Group. N Engl J Med.

(2000)

Nutrition and Your Health: Dietary Guidelines for Americans. 5th ed. Washington, DC: US Depts of Agriculture and Health...

Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols....

M.K. Campbell et al.

Vegetable and fruit consumption and prevention of cancerthe Black Churches United for Better Health Project

Am J Public Health.

(1999)

T.A. Nicklas et al.

Outcomes of a high school program to increase vegetable and fruit consumptionGimme 5—a fresh nutrition concept for students

J Sch Health.

(1998)

S. Havas et al.

Final results of the Maryland WIC 5-A-Day Promotion Program

Am J Public Health.

(1998)

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Changes in vegetable and fruit consumption and awareness among US adults: Results of the 1991 and 1997 5 A Day for Better Health Program surveys

Abstract

Section snippets

Design

Sample

Results

Message Awareness

Applications/Conclusions

J Am Diet Assoc.

Prev Med.

Prev Med.

J NutrEduc.

J Am Diet Assoc.

J Am Diet Assoc.

Am J Clin Nutr.

Appetite.

J Am Diet Assoc.

The annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer

Cancer.

Fruits, vegetables, and cancer preventiona review of the epidemiological evidence

Nutr Cancer.

Potter JD Vegetable, fruit and cancer

I. Epidemiology. Cancer Causes Control.

Fruits and vegetables in the prevention of cancer and cardiovascular disease

Public Health Nutr.

Epidemiological studies on brassica vegetables and cancer risk

Cancer Epidemiol Biomarkers Prev.

Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas

Polyp Prevention Trial Study Group. N Engl J Med.

Vegetable and fruit consumption and prevention of cancerthe Black Churches United for Better Health Project

Am J Public Health.

Outcomes of a high school program to increase vegetable and fruit consumptionGimme 5—a fresh nutrition concept for students

J Sch Health.

Final results of the Maryland WIC 5-A-Day Promotion Program

Am J Public Health.