Achieving equity in Crunch&Sip®: a pilot intervention of supplementary free fruit and vegetables in NSW classrooms
Debra Hector A B , Shelley Edwards C , Joanne Gale B and Helen Ryan C DA Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia.
B Prevention Research Collaboration, School of Public Health, Charles Perkins Centre, D17, University of Sydney, Camperdown, NSW 2006, Australia.
C Western Sydney Local Health District, Cumberland Hospital Campus, Gungurra, Building 68, Fleet Street, North Parramatta, NSW 2151, Australia.
D Corresponding author. Email: helen.ryan@health.nsw.gov.au
Health Promotion Journal of Australia 28(3) 238-242 https://doi.org/10.1071/HE16095
Submitted: 7 September 2016 Accepted: 29 January 2017 Published: 24 April 2017
Abstract
Issue addressed: Anecdotal evidence from teachers in Western Sydney Local Health District (WSLHD) indicated that many primary school children are regularly unable to participate in the Crunch&Sip® (C&S) program (breaks during class time to eat fruit and/or vegetables and drink water) as they do not bring produce from home. Actual reach of the program may therefore be currently overestimated, and inequitable. This study examined the feasibility, acceptability and efficacy of providing school children supplementary, fresh free produce in supporting equitable participation in C&S.
Methods: Free fruit and vegetables were provided for 10 weeks to four schools in a socioeconomically-disadvantaged area in Western Sydney. WSLHD sourced the produce at a discounted rate and storage and distribution was arranged in partnership with industry. Schools determined methods of allocation to children who did not have fruit or vegetables for the C&S break. Pre- and late-intervention (Week 9) classroom surveys provided quantitative data of intervention efficacy. Qualitative methods were used with key school persons to explore barriers and enablers to implementation.
Results: Participation of children in C&S increased significantly from 46.7% pre-intervention to 92.0% in Week 9. The proportion of children bringing fruit or vegetables from home also increased significantly, from 46.7% to 54.0%. Schools perceived the supplementary strategy to be highly feasible and acceptable.
Conclusion: Expansion of this equity strategy warrants consideration, although issues of sustainability would need to be addressed. The criteria for ‘full implementation’ should include high proportional participation by students in participating classes.
So what?: Establishing a system by which schools in disadvantaged areas can supplement their C&S program would effectively increase access to fruit and vegetables among those children most at need.
References
[1] Australian Bureau of Statistics. 033.0.55.001 Census of population and housing: Socio-Economic Indexes for Areas (SEIFA), Australia – data only, 2006. 2008. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/2033.0.55.0012006?OpenDocument [Verified 27 February 2017].[2] Australian Bureau of Statistics. 2039.0 – Information paper: an introduction to Socio-Economic Indexes for Areas (SEIFA), 2006. 2008. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/2039.0 [Verified 27 February 2017].
[3] Baum S (2004) Measuring socio-economic outcomes in Sydney: an analysis of census data using a general deprivation index. Australas J Region Stud 10, 105–31.
[4] Fogarty AW, Antoniak M, Venn AJ, Davies L, Goodwin A, Salfield , et al (2007) Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children? Int J Epidemiol 36, 1080–5.
| Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2snit1CrsQ%3D%3D&md5=1336522720b5778b5d9c00d7299ec6a0CAS |
[5] He M, Beynon C, Sangster Bouck M, St Onge R, Stewart S, Khoshaba L, et al (2009) Impact evaluation of the Northern Fruit and Vegetable Pilot Programme – a cluster-randomised controlled trial. Public Health Nutr 12, 2199–208.
| Impact evaluation of the Northern Fruit and Vegetable Pilot Programme – a cluster-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[6] Øvrum A, Bere E (2014) Evaluating free school fruit: results from a natural experiment in Norway with representative data. Public Health Nutr 17, 1224–31.
| Evaluating free school fruit: results from a natural experiment in Norway with representative data.Crossref | GoogleScholarGoogle Scholar |
[7] Tak NI, Te Velde SJ, Brug J (2009) Long-term effects of the Dutch Schoolgruiten Project – Promoting fruit and vegetable consumption among primary-school children. Public Health Nutr 12, 1213–23.
| Long-term effects of the Dutch Schoolgruiten Project – Promoting fruit and vegetable consumption among primary-school children.Crossref | GoogleScholarGoogle Scholar |
[8] Ashfield-Watt PA, Stewart EA, Scheffer JA (2009) A pilot study of the effect of providing daily free fruit to primary-school children in Auckland, New Zealand. Public Health Nutr 12, 693–701.
| A pilot study of the effect of providing daily free fruit to primary-school children in Auckland, New Zealand.Crossref | GoogleScholarGoogle Scholar |
[9] Healthy Kids Association NSW. Crunch&Sip® School implementation checklist. 2015. Available from: https://www.healthykids.nsw.gov.au/downloads/file/campaignsprograms/CSSchoolChecklist_FINAL.pdf [Verified 27 February 2017].
[10] Nathan N, Wolfenden L, Bell AC, Wyse R, Morgan PJ, Butler M, et al (2012) Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial. BMC Public Health 12, 651
| Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[11] HealthStats NSW. Fruit and vegetables: recommended daily consumption, children aged 2–15 years, NSW 2004–2005 to 2014–2015. 2016. Available from: http://www.healthstats.nsw.gov.au/Indicator/beh_vegkid_age/beh_vegkid_age [Verified 6 March 2017].
[12] Glasson C, Chapman K, James E (2011) Fruit and vegetables should be targeted separately in health promotion programmes: differences in consumption levels, barriers, knowledge and stages of readiness for change. Public Health Nutr 14, 694–701.
| Fruit and vegetables should be targeted separately in health promotion programmes: differences in consumption levels, barriers, knowledge and stages of readiness for change.Crossref | GoogleScholarGoogle Scholar |
[13] Wiese M, Jolley G, Johns J. Crunch and Sip Evaluation Report. South Australian Community Health Research Unit, Flinders University. 2011. Available from: http://www.phcris.org.au/phplib/filedownload.php?file=/elib/lib/downloaded_files/roaroutput/report_5983.pdf [Verified 31 January 2017].
[14] Murakami K, Livingstone MB (2015) Eating frequency is positively associated with overweight and central obesity in U.S. adults. J Nutr 145, 2715–24.
| Eating frequency is positively associated with overweight and central obesity in U.S. adults.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XhtlGrsL%2FJ&md5=420a5863de52215c93566c94de72b0c5CAS |
[15] Evans EW, Jacques PF, Dalla GE, Sacheck J, Must A (2015) The role of eating frequency on relative weight in urban school-age children. Pediatr Obes 10, 442–7.
| The role of eating frequency on relative weight in urban school-age children.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MvktFerug%3D%3D&md5=58815be9cda93a418e17e02c4e31ba6bCAS |
[16] Drummond SE, Crombie NE, Cursiter MC, Kirk TR (1998) Evidence that eating frequency is inversely related to body weight status in male, but not female, non-obese adults reporting valid dietary intakes. Int J Obes Relat Metab Disord 22, 105–12.
| Evidence that eating frequency is inversely related to body weight status in male, but not female, non-obese adults reporting valid dietary intakes.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7mt1ynsA%3D%3D&md5=b5c46f4ead7d761b300e3ee8164b2fb9CAS |
[17] Aljuraiban GS, Chan Q, Oude Griep LM, Brown IJ, Daviglus ML, Stamler J, et al (2015) The impact of eating frequency and time of intake on nutrient quality and Body Mass Index: the INTERMAP Study, a population-based study. J Acad Nutr Diet 115, 528–536.e1.
| The impact of eating frequency and time of intake on nutrient quality and Body Mass Index: the INTERMAP Study, a population-based study.Crossref | GoogleScholarGoogle Scholar |
[18] Kelishadi R, Qorbani M, Motlagh ME, Heshmat R, Ardalan G, Bahreynian M (2016) Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study. J Pediatr 92, 156–67.
| Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study.Crossref | GoogleScholarGoogle Scholar |
[19] Murakami K, Livingstone MB (2016) Decreasing the number of small eating occasions (<15% of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents. Br J Nutr 115, 332–41.
| Decreasing the number of small eating occasions (<15% of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2MXitVSqsLvI&md5=db8404126a9e54be35b39c194c9d15afCAS |
[20] Coyle KK, Potter S, Schneider D, May G, Robin LE, Seymour J, et al (2009) Distributing free fresh fruit and vegetables at school: results of a pilot outcome evaluation. Public Health Rep 124, 660–9.
| Distributing free fresh fruit and vegetables at school: results of a pilot outcome evaluation.Crossref | GoogleScholarGoogle Scholar |
[21] Potter SC, Schneider D, Coyle KK, May G, Robin L, Seymour J (2011) What works? Process evaluation of a school-based fruit and vegetable distribution program in Mississippi. J Sch Health 81, 202–11.
| What works? Process evaluation of a school-based fruit and vegetable distribution program in Mississippi.Crossref | GoogleScholarGoogle Scholar |