1. Ontario’s Action Plan for Healthy Eating & Active Living E VALUATION OF THE N ORTHERN F RUIT & V EGETABLE P ILOT P ROGRAM – A R ANDOMIZED C ONTROLLED T RIAL Meizi He Charlene Beynon Michelle Sangster Bouck

2. Team Members PHRED Evaluation Team Members: Meizi He, Middlesex-London Health Unit Charlene Beynon, Middlesex-London Health Unit Linda Khoshaba, Middlesex- London Health Unit Michelle Sangster Bouck, Middlesex-London Health Unit Renée St Onge, Sudbury & District Health Unit Susan Stewart, Kingston, Frontenac and Lennox & Addington Public Health Elaine Murkin, Ottawa Public Health Suzanne Lemieux, Middlesex-London Health Unit Porcupine Health Unit: Betty Ann Horbul Bill Chircoski

3. The Northern Fruit and Vegetable Pilot Program (NFVPP) School-based free fruit and vegetable snack (FFVS) intervention targeting elementary school-age children in Northern Ontario FFVS 3 times/week with or without enhanced nutrition education (ENE) for 24 weeks Funded by the Ontario Ministry of Health Promotion and implemented by Porcupine Health Unit in partnership with the Ontario Fruit and Vegetable Growers’ Association

4. Evaluation Objectives Evaluation Objectives Process Evaluation –identify facilitators and challenges to implementation Impact Evaluation –impact of NFVPP on students’ fruit and vegetable consumption patterns –impact of NFVPP on students’ awareness, knowledge, preference and willingness to try fruit and vegetables

5. Study Design 32 schools 6 schools (JK-G4) 26 schools (JK-G8) Intervention I FFVS+ENE Intervention II FFVS Control Process Evaluation 24 schools FV waste tracking In-depth interviews Impact Evaluation Primary Outcomes – FV consumption Secondary Outcomes – cognitive and behavioural scores Moderators – age, gender, language spoken at home Grade 5-8 students in 9 schools Grade 5-8 students in 9 schools Grade 5-8 students in 8 schools 6 schools (JK-G4) 9 schools (JK-G8) 8 schools (JK-G8)

6. Process Evaluation - Methods 28 in-depth telephone interviews with principals, teachers and food preparers Weekly fruit and vegetable waste tracking throughout the program.

7. Impact Evaluation - Methods Cluster-randomized controlled design –Intervention I: FFVS + ENE –Intervention II: FFVS and routine nutrition education –Control: routine nutrition education Students in Grades 5-8 Baseline and Endpoint (Dec. 2006-June 2007)

8. Process Evaluation - Findings Valuable Program “Being able to offer this at school level, it’s a great thing and often students don’t have this exposure at home.... it’s a great program and we really enjoyed it and thought it was very beneficial to our students.” (principal) “The impact is positive and I think the kids are starting to understand healthy eating.” (principal)

9. Facilitators Funding “I think with the funding and being able to hire someone to do all this, made it run very smoothly. If we were to do it on a volunteer basis, not have that funding, it would have been a lot more difficult.” (principal) Participation of the School Community “What made it? It’s everyone’s participation. The teachers were very eager and the children were always happy to see what was coming into the classrooms.” (food preparer)

10. Challenges Product Delivery “One of the challenges that we’ve had here, was the delivery of it. We had a lot of problems with the delivery and it’s being delivered without the school’s knowledge.” (food preparer) “Most of the time I had to cut off much of them [the vegetables].... I was just trying to make these very old vegetables servable.” (food preparer) Quality - especially vegetables Variety - especially fruit Waste

11. Estimated Fruit & Vegetable Wasting (n=621) (n=621)

12. R ESULTS F ROM I MPACT E VALUATION …

13. Sample Scheme Intervention II FFVS 9 schools JK-Grade 8 Total n=1625 Intervention I FFVS+ENE 9 + 6 = 15 schools JK-Grade 8 Total n=3104 Control 8 schools JK-Grade 8 n=1659 9 schools Grades 5-8 n=603 / 836 9 schools Grades 5-8 n=492 / 652 8 schools Grades 5-8 n=491 / 766 n=400 / 492 n=470 / 603n=407 / 491 Intervention Evaluation: Baseline Evaluation: Endpoint

14. Intervention Effect Fruit and Vegetable Intake at Endpoint *p< 0.05 by Post Hoc multiple comparison using the LSD pairwise comparison

15. Intervention Effect Changes in preferences Intervention I **p<0.01 by Chi-Square Test

16. Intervention Effect Changes in preferences Intervention II *p<0.05; **p<0.01 by Chi-Square Test

17. Intervention Effect Changes in preferences Control **p<0.01 by Chi-Square Test

18. Intervention Effect Changes in intention, self-efficacy & peer influence Intervention II *p<0.05 by Chi-Square Test

19. Impact Evaluation - Summary The combined intervention strategy increased F&V intake by 0.5 serving/day at school Interventions resulted in favourable preference changes on certain fruit and vegetables There appears to be a tendency towards unfavourable changes in intention, self-efficacy, and peer influence pertaining to vegetable consumption in the Intervention II group (FFVS only)

20. Policy and Practice Implications The NFVP program appears to be a valuable and effective program Future intervention programs should consider: –using a combined intervention strategy (FFVS + ENE) –offering fruit & vegetables with adequate quality, quantity and variety –ensuring appropriate delivery of produce Sufficient funding and good coordination are essential

21. For a copy of the Final Report go to: www.mhp.gov.on.ca/english/health/HEAL/default.asp

22. For further information... Charlene Beynon Director cbeynon@uwo.ca Dr. Meizi He Nutrition Researcher/Educator meizi.he@mlhu.on.ca Middlesex-London PHRED Program 50 King Street London, ON N6A 5L7