1. University of Wisconsin-Eau Claire Expanding the Reach of the USDA Fresh Fruit & Vegetable Snack Program: Do Incentives and Reminders Work? Faculty Researchers: Dr. Lori Bica and Dr. Eric Jamelske Student Researchers: April Ross, Kevin Reinhold, Elizabeth Reinke, Laurelyn Wieseman Aaron Wingad University of Wisconsin-Eau Claire Economics & Psychology Departments Chippewa Valley Center for Economic Research & Development

2. University of Wisconsin-Eau Claire Overview  Introduction  USDA Fresh Fruit & Vegetable Program  2008-09 Evaluation –Morning Snack  2009-10 Evaluation –Daily Snack Track –Incentives & Reminders  Questions and Discussion

3. Introduction  Overweight and obesity among children (and adults).  Nearly 30% of youth are overweight/obese or at risk.  Significant health care concern, annual costs in the BILLIONS of $.

4. Introduction  Inadequate fruit and vegetable consumption (not 5-9 a day).  Lots of less healthy alternatives.

5. Introduction  Use school setting to address this very important issue.  USDA created Fresh Fruit and Vegetable Snack Program (FFVP) to improve nutrition and help combat childhood obesity (2002).

6. University of Wisconsin-Eau Claire  The FFVP provides funding for students from selected schools to receive a free fruit or vegetable (FV) snack 3-4 days a week for an academic year.  Wisconsin first received FFVP funding in 2006 and the FFVP was expanded to all 50 states plus the District of Columbia, Guam, Puerto Rico and Virgin Islands through the 2008 US Farm Bill.  USDA –http://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htmhttp://www.fns.usda.gov/cnd/FFVP/FFVPdefault.htm  Wisconsin Department of Public Instruction –http://dpi.wi.gov/fns/ffvp.htmlhttp://dpi.wi.gov/fns/ffvp.html The Fresh Fruit & Vegetable Program

9. University of Wisconsin-Eau Claire  4 Western Wisconsin Elementary Schools –2 intervention and 2 matched control –4 th and 5 th grade students –pre-test/post-test experimental design  Survey questions –How many FV do students eat? –Day In The Life Questionnaire (DILQ) –Average daily F/V intake (measured over 3 days) 2008-09 Evaluation Process

12. University of Wisconsin-Eau Claire 2008-09 Evaluation Process  Pre-test survey – late September 2008  Program began – early October 2008  Morning snack in classroom (3 or 4 days a week)  Post-test survey – late April 2009  Pre-test – Post-test change in FV intake –DILQ, average daily F/V intake (measured over 3 days)

13. University of Wisconsin-Eau Claire Pre-Test Fruit & Vegetable Intake  Students do not eat close to five-a-day (1.68).  Eat more fruits than veggies.  Nearly two-thirds of FV intake from school lunch.  Don’t eat FV at home in morning or afterschool snack.  No real baseline differences between intervention and control. –Differences in school lunch menu on survey days (1.56 > 1.81)

14. Pre-Test Fruit & Vegetable Intake

15. Change in FV Intake at Morning Snack  School 1: watermelon (92%), cucumber (73%), apple (81%) –Fruit: 2 out of 3 days (2/3) Vegetable: 1 out of 3 days (1/3)  School 2: none, grapes (84%), carrots (62%) –Fruit: 1 out of 3 days (1/3) Vegetable: 1 out of 3 days (1/3)

16. Morning Snack Comparison  Free F/V morning snack (Tuesday survey, Monday recall) –Intervention school 1: watermelon (92%) –Intervention school 2: no free fv snack  Intervention school 1 has large fruit am snack  Intervention school 2 reverts to baseline fruit am snack  Limited program effect

17. University of Wisconsin-Eau Claire FV Intake Distribution Shift  % of students reporting FV intake of >= 1.5

18. University of Wisconsin-Eau Claire Regression Analysis  OLS regression examines whether earlier findings of a positive program effect are robust to the inclusion of control variables.  The dependent variable = the change in average daily fruit and vegetable intake between the pre-test and the second post-test.  Dummy variable for each intervention school (SCH), dummy variables for the type of lunch typically eaten (LNCH), the average daily fruit and vegetable intake on the pre-test (FV) and dummy variables for gender, grade, and race (DEM).

20. University of Wisconsin-Eau Claire Conclusion  The FFVP Works!  All else equal, the FFVP ↑ average daily FV intake among intervention students by about 1/2 serving (compared to control).  Program effect is limited.  No evidence of ↑ FV intake without free access. –Breakfast, after-school snack, dinner, night-time snack, non-FFVP days. If students are provided with free FV with no alternatives THEY EAT THEM!

21. University of Wisconsin-Eau Claire 2009-10 Research Evaluation  Four New Western Wisconsin elementary schools.  Pre-test/Post-test experimental design (intervention and control). –Just entered survey data, no FV intake analysis yet.  One intensive intervention school*  Daily FV snack tracking*

22. University of Wisconsin-Eau Claire Intensive Intervention  4 th and 5 th grade classrooms (4).  Free FV snacks served three days a week for afternoon snack.  1. Do students eat the free snacks served?  2. Do students bring FV snacks from home on non-FFVP snack days?

23. F&V Snack Track – Binder - Wall Chart  Teacher tracks daily FV snack behavior of students.  Wednesday & Friday are non-FFVP snack days.

31. University of Wisconsin-Eau Claire Conclusion  Students typically eat the free FV snacks.  Fruits are more popular than vegetables.  Common items are more popular than new items.  No real evidence that students develop a liking for FV from repeated exposure.  No real evidence of positive effect from forcing children to try FV snacks.

32. Non-Free Snack Days  Six distinct periods of study (October 2009 – May 2010)  Nothing  Wall chart with stickers  Toy prizes  Positive modeling/praise  Homework reminders  Period One = 3 weeks, 6 days  Period Two = 3 weeks, 6 days  Period Three = 2 weeks, 4 days  Period Four = 2 weeks, 4 days  Period Five = 10 weeks, 20 days  Period Six 7 weeks, 14 days

33. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders & Modeling/Praise Reminders, Modeling/Praise & Toys

34. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders, Modeling/Praise & Toys

35. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders, Modeling/Praise & Toys

36. Nothing Chart & Stickers Chart, Stickers & Toys Nothing Reminders, Modeling/Praise & Toys

37. University of Wisconsin-Eau Claire Expanding the Reach of the FFVP  TOY PRIZES MATTER!  Most successful combined with POSITIVE MODELING & PRAISE!  A caring and dedicated teacher was able to get 70% of her students to bring FV snacks from home on a regular basis.

38. University of Wisconsin-Eau Claire Expanding the Reach of the FFVP

39. University of Wisconsin-Eau Claire Expanding the Reach of the FFVP  Framework for schools to expand the reach of the FFVP beyond the access to free FV provided as snacks in the classroom.  This incentive scheme is both feasible and affordable in terms of time, resources and money….schools can do this.  And it seems to work effectively!

40. University of Wisconsin-Eau Claire Future Work (2009-10)  We are excited to analyze the 2009-10 data further to see if the students in this intervention school increased FV intake more than the other intervention school (with the FFVP, but no incentives)  Perhaps we will find that giving students incentives to bring FV snacks from home on their own will also lead to these students eating more FV at other times (morning, afterschool snack).  We are HOPEFUL, but not DELUSIONAL.

44. Eric Jamelske & Lori Bica jamelsem@uwec.edu, bicala@uwec.edu jamelsem@uwec.edubicala@uwec.edu Questions?

45. University of Wisconsin-Eau Claire Free and Discount Coupons  34 families of students from the two intervention schools were given 5 free coupons each redeemable for $2 free FV (valid one week).  Same families also given 3 discount coupons each redeemable for $2 off a $5 FV purchase (valid the following week).  Coupon redemption rates.  DILQ given 3 days during week that free coupons were valid.  Did students that redeemed free coupons show increased FV intake compared to control group from same schools?

46. Free and Discount Coupons  Nearly every family took advantage of the free coupons which required nothing more than a trip to the grocery store to buy the FV.  27 families redeemed all free coupons (79.4%).  Most families did not make use of the discount coupons (15.7%) which would have required them to spend some of their own money in addition to going to the grocery store.

48. University of Wisconsin-Eau Claire Conclusion  Small, but significant increase in FV intake among free coupon students compared to control students.  Limited to FRUIT: breakfast, dinner and night-time snack.  Increases occurred when parents were likely home.  Schools cannot afford to use free FV coupons to expand the reach of the FFVP into the home.  This research could be applied to other USDA programs -WIC and Food Stamps (more on this later).

49. University of Wisconsin-Eau Claire Future Work (2010-11)  Not so much FFVP evaluation.  More free FV coupons.  4 th grade classes in two area elementary schools will be given $15 worth of free FV coupons each week for four consecutive weeks.  Baseline FV intake survey followed by surveys in the 2 nd and 4 th weeks of coupons, followed by surveys in the 2 nd and 4 th weeks after coupons are taken away.  Coupon redemption rates, increased FV intake.