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R2: Fruits & Vegetables*

Framework Component

Population Results - Trends and Reductions in Disparities

Indicator Description

This indicator represents changes in fruit and vegetable consumption, including subgroups of under-consumed vegetables, over time, from year to year, among the low-income population of the state. Unlike MT1 and LT1 (Healthy Eating Behaviors), which measure increases in fruit and vegetable intake attributed to SNAP-Ed series-based programs, R2 is intended to measure the proportion of the SNAP-Ed eligible population that is achieving the Dietary Guidelines for Americans recommendations. Thus, R2 measures fruit and vegetable consumption status for low-income households surveyed within the state or area of focus. R2 is a population-level surveillance measure.

*SNAP-Ed Priority Outcome Indicator

Background and Context

The current Dietary Guidelines for Americans recommends intake of 1 to 2½ cups of fruit per day and 1 to 4 cups per day of vegetables based on daily calories consumed. Most Americans are not eating enough fruits and vegetables. According to CDC's Fruit and Vegetable Indicator Report, 2013, adults eat fruit 1.1 times per day, and vegetables approximately 1.6 times per day. Three vegetable subgroups-legumes, dark green vegetables, and orange-colored vegetables-are particularly nutrient dense and significantly under-consumed by Americans across most age and gender groups. "Making half your plate fruits and vegetables" is an important aspect of the Dietary Guidelines for Americans, and fruit and vegetable consumption is often used as a marker of a general healthy diet.

Outcome Measures

Number or percentage of SNAP-Ed eligible persons who ate:

R2a. Fruits one or more times per day (or, median number of times or cups consumed daily)

  1. 100 percent PURE fruit juices
  2. Fruit, including fresh, frozen, or canned fruit (not counting juice)

R2b. Vegetables one or more times per day (or, median number of times or cups consumed daily)

  1. Cooked or canned beans (not including long green beans)
  2. Dark green vegetables
  3. Orange-colored vegetables
  4. Other vegetables

What to Measure

Adults

  1. Number or percentage of adults who ate fruit or drank 100 percent fruit juice
    • Number or percentage of adults who drank 100 percent fruit juice
    • Number or percentage of adults who ate whole fruit (not juice)
  2. Number or percentage of adults who ate vegetables
    • Number or percentage of adults who ate cooked or canned beans (legumes)
    • Number or percentage of adults who ate dark green vegetables
    • Number or percentage of adults who ate orange-colored vegetables
    • Number or percentage of adults who ate other vegetables

Children/Adolescents

  1. Number or percentage of children/adolescents who ate fruit or drank 100 percent fruit juice
    • Number or percentage of children/adolescents who drank 100 percent fruit juice
    • Number or percentage of children/adolescents who ate whole fruit (not juice)
  2. Number or percentage of children/adolescents who ate vegetables
    • Number or percentage of children/adolescents who ate cooked or canned beans (legumes)
    • Number or percentage of children/adolescents who ate dark green vegetables
    • Number or percentage of children/adolescents who ate orange-colored vegetables
    • Number or percentage of children/adolescents who ate other vegetables

Population

Youth (pre-school and above) or Adults

Surveys and Data Collection Tools

The Behavioral Risk Factor Surveillance System (BRFSS) is one national surveillance survey that can potentially collect fruit and vegetable consumption data from adults; however, the fruit and vegetable module is optional, so it is not asked annually. The Youth Risk Behavior Surveillance System collects fruit and vegetable consumption data from high school-age youth, but it is administered every 2 years and at least one state does not participate. As an alternative, evaluation data can be collected by 1) adding a module of questions like those listed below to a statewide survey collecting population data that can identify the low-income segment of its sample, such as your state's BRFSS; 2) conducting a population-level 24-hour recall with your state SNAP-Ed population or another representative low-income population sample; or 3) conducting another type of annual data collection that includes these questions from either your total SNAP-Ed population or a representative random sample of it. The same question module should be used year-to-year for consistency.

ADULTS

CHILDREN & YOUTH

Additional Resources or Supporting Citations

1 Indicator R2 measures fruit and vegetable consumption among low-income children and adults using public health surveillance tools, such as the Behavioral Risk Factor Surveillance System (BRFSS) and the Youth Risk Behavior Surveillance System (YRBSS). CDC maintains a Nutrition, Physical Activity, and Obesity Data, Trends and Maps website, available at https://www.cdc.gov/nccdphp/DNPAO/index.html. The CDC data include cross-tabulations by race/ethnicity, income, and gender, which are useful for tracking disparities.

While not every state, territory, or tribe administers these surveys, they represent the most definitive sources on health risk behaviors at the state level. Other states could incorporate the aforementioned survey questions in their own locally administered health surveys.

Previously, the BRFSS used five times per day combined fruit and vegetable consumption as a target; however, in the July 2015 Morbidity and Mortality Weekly Report (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a1.htm?s_cid=mm6426a1_e), experts from CDC and the National Cancer Institute describe a new methodology that aligns participant responses in the BRFSS survey with recommendations that are age- and sex-specific and are appropriate for adults who engage in.

One area of potential confusion in R2 is the referent time period. The BRFSS asks participants to identify the number of times in the past day, week, and month when they consumed fruit and vegetables; the YRBSS uses the past seven days; and EFNEP Youth Surveys use yesterday. Evaluators should denote their time period when reporting results and use the same time periods for long-term trend analysis.

Additional Source CDC State Indicator Report on Fruits and Vegetables, 2013

https://www.naccho.org/uploads/downloadable-resources/national-action-guide2013.pdf