The Gillings Sustainable Agriculture Project: A Gillings Innovative Laboratory


Barriers to Fresh Fruit and Vegetable Intake

By Emily Welker

 
Currently only ~25% of Americans are meeting the USDA’s recommendations for fruit and vegetable consumption7…Why is that? What are the solutions to this problem? 
 
 
Cardiovascular disease and cancer are the leading causes of death in the US5. Eating fresh fruits and vegetables (FFV) has significant protective effects against these conditions, so the USDA suggests we fill half our plate at each meal with fruits and vegetables. 
 
1) Price and spoilage:
  • Fresh fruits and vegetables (FFV) are more expensive per kCal4—barrier for low income populations
  • People fear that FFV will perish before eaten and money will be wasted2, 10, 13
  • Low income populations may lack equipment to store FFV such as a refrigerator10
2) Availability and quality:
  • Produce selection in certain regions, especially rural and minority/low-income areas, is often limited8, 10
  • 2.3 million Americans live more than 1 mile from a supermarket and do not own a car9
  • 23.5 million people live in low-income areas that are more than 1 mile from a supermarket9

3) Preparation Time Relative to Processed Food1, 10,13:

  • Young people perceive the time and effort required to prepare FFV as a significant barrier13

4) Family Influence:

  • Strong determinant in creating taste preferences and dietary patterns1, 2,10, 13

5) Nutrition Education:

  • Lack of understanding of the USDA recommended servings of FFV1
  • Lack of education of how to purchase, store, and prepare FFV2

6) Gender:

  • In general, males are less concerned about nutrition, perceive less benefits in eating FFV, and feel less susceptible to chronic disease2, 3,13

6 Ways to Reduce These Barriers

1) Align federal food and farming policy with nationwide nutrition and public health goals11:

  • Government support of specific crops (corn and soybeans) keeps the cost of high fat, high sugar foods artificially low11
  • Restructuring these policies could address the price barrier to FFV consumption11

2) Increase FFV availability in emergency food programs12:

  • Would address the issue of access for low-income populations12
  • Must be paired with education and training of how to prepare and store FFV12

3) Create policies to get FFV curriculum and activities into schools12:

  • Provides access to school children and changes dietary preferences12
  • FFV preparation, school gardens, and cooking classes give students a “personal connection to food and a lasting relationship with healthy eating”12

4) Open Farmer’s Markets and Connect Low-Income Populations with Community Supported Agriculture12

  • Farmers’ Markets are faster and easier to open than grocery stores and both markets and CSAs increase access to affordable FFV and support regional food producers12
  • Need to establish systems in which SNAP and WIC benefits can be used to purchase produce at farmers’ markets and through CSAs12

5) Create local food policy councils12:

  • Can advise governments and citizens about ways to improve the local food system and increase access to affordable, healthy food12
  • Bring together wide variety of stakeholders: health, education, public, private, agriculture12

6) Improve access to food retail in food deserts12:

  • Create policies that provide tax incentives for development or assistance with land acquisition12
  • Provide public transportation to and from these venues12

 
 
 
1. Chuan Ling, A. M, and C. Horwath. Perceived Benefits and Barriers of Increased Fruit and Vegetable Consumption: Validation of a Decisional Balance Scale. Journal of Nutrition Education 33, no. 5 (2001): 257265.This article describes conclusions from surveys that were conducted in order to better understand people’s perceived barriers to FFV intake. Chuan Ling et. al. discovered that cost in time and money, effort to prepare, difficulty changing habits, preference for other foods, lack of availability, concerns about pesticides, and lack of awareness of dietary guidelines were the greatest barriers. I found this article through a google scholar search.

2. Dibsdall, L. A., N. Lambert, R. F. Bobbin, L. J. Frewer, and others. Low-income Consumers Attitudes and Behaviour Towards Access, Availability and Motivation to Eat Fruit and Vegetables. Public Health Nutrition 6, no. 2 (2003): 159168.

This 10 page paper is very much like Chuan Ling et. al.’s work in that it is also a collection of survey data aimed at better understanding people’s attitudes and behaviors surrounding FFV intake. However, their focal points differed because Dibsdall et. al, focused more on the effects of gender or marital status on FFV intake. They also found that lack of cooking skills, lack of nutrition education, and family upbringing were significant barriers to FFV intake. I found this article on google scholar.

3. Dittus, K. L, V. N Hillers, and K. A. Beerman. Benefits and Barriers to Fruit and Vegetables Intake: Relationship Between Attitudes and Consumption. Journal of Nutrition Education 27 (1995).

Dittus et. al’s work focuses on people’s attitudes about health and their feelings of susceptibility to disease and how those factors might affect fruit and vegetable consumption. Their findings highlight the effects of gender and education on these attitudes and beliefs.  I found this article to be helpful because it provided some insight into why fruit and vegetable consumption is so different among males and females. I found this paper though a google scholar search.

4. Drewnowski, A. Fat and Sugar: An Economic Analysis. The Journal of Nutrition 133, no. 3 (2003): 838S840S.

This 3-page article provides an economic analysis of the current obesity epidemic in the United States and of the price per unit of energy of specific types of food. Drenowski, a professor at the University of Washington’s school of public health, is interested in the lowering of the cost of energy through added sugars and fats. This article was very helpful to me in determining whether or not FFV were really more expensive than processed foods high in fat and sugar. It provided an interesting way for me to think about price, instead of price per pound of food, this article considers price per unit of energy consumed. This is a more important measure when considering low-income populations who often want food that will fill them up for the lowest price. I found this article through a google scholar search and it was cited in several of the other papers I read.

5. FASTSTATS – Leading Causes of Death, n.d. http://www.cdc.gov/nchs/fastats/lcod.htm.

This source is from the CDC and I used it to verify that heart disease and cancer were the leading causes of death in the US.

6. Food Desert Locator, n.d. http://www.ers.usda.gov/data/fooddesert/fooddesert.html.

This map from the ERS was used to show where in the US there are food deserts.

7. Fruit and Vegetable Consumption Data and Statistics, n.d. http://apps.nccd.cdc.gov/5ADaySurveillance/.

This CDC website allows you to select different criteria (age, gender, SES) and it displays data on FFV consumption in the US.

8. Glanz, K., and A. L Yaroch. Strategies for Increasing Fruit and Vegetable Intake in Grocery Stores and Communities: Policy, Pricing, and Environmental Change. Preventive Medicine 39 (2004): 7580.

This 6-page article describes different strategies for increasing fruit and vegetable intake. I mostly used this article for its information on the current need for grocery stores in low-income communities and on the impact of grocery stores on the intake of FFV, although it also provides some interesting information on the importance of advertising FFV and point of purchase information. I found this article on google scholar.

9. Ver Ploeg, M. Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences: Report to Congress. DIANE Publishing, 2010.

This article is a summary composed by the Economic Research Service about barriers to affordable and nutritious food. I used this source for my statistics regarding food deserts and the number of Americans living in food deserts. I found this source on google scholar.

10. Sisson, A. Fruit and Vegetable Consumption by Low-income Americans. Nutrition Noteworthy 5, no. 1 (2002).

This article focuses on the barriers to FFV consumption specifically for low-income Americans. The data collected in their survey are extremely important because low-income populations consume the least amount of fruits and vegetables, so their deterrents for consumption should be the main focus of policies and interventions. Factors such as cost, taste, selection/availability, convenience, and storage space for fresh food were all found to be significant barriers. I found this article on google scholar.

11. Story, M., K. M Kaphingst, R. Robinson-OBrien, and K. Glanz. Creating Healthy Food and Eating Environments: Policy and Environmental Approaches. Annu. Rev. Public Health 29 (2008): 253272.

Story et. al. wrote this paper in order to put forward both environmental and policy solutions to the growing obesity epidemic in the United States. They provide some very valuable insights about how the subsidy system in the United States affects both price and consumption of fruits and vegetables, and how these factors in turn affect the health of Americans.  Overall, this paper focuses on specific locations (schools, child care, etc) that have the potential to be successful intervention sites and some policy suggestions for how to enact these macro-scale changes. I found this paper on google scholar.

12. Strategies to Increase FV Consumption.pdf, n.d. http://www.ncpanbranch.com/Coalitions/pppConference/Strategies%20to%20Increase%20FV%20Consumption.PDF.

This source is the CDC’s 56-page guide on how to increase fruit and vegetable consumption by addressing issues of access and availability. The guide provides seven comprehensive solutions and each one includes strategy, definition, rationale, evidence of effectiveness, action steps, key considerations, and program examples. This source was extremely helpful to me in thinking about ways to reduce barriers to FFV intake. I found this source through a regular google search.

13. Yeh, M. C, S. B Ickes, L. M Lowenstein, K. Shuval, A. S Ammerman, R. Farris, and D. L Katz. Understanding Barriers and Facilitators of Fruit and Vegetable Consumption Among a Diverse Multi-ethnic Population in the USA. Health Promotion International 23, no. 1 (2008): 4251.

Yeh et. al. provide a comprehensive survey of both the barriers and facilitators of fruit and vegetable consumption in multiple ethnic populations in the United States. They found some barriers, such as cost and time, to be consistent among all 3 ethnic groups (Hispanic, African-American, Caucasian). Some factors such as media influence and access were ethnicity-specific, to Hispanics and African-Americans respectively. I found this article using google scholar.

14. Fruits & Veggies More Matters: Home: Health Benefits of Fruits & Vegetables, http://www.fruitsandveggiesmorematters.org/.

I used this cite to find the USDA’s updated FFV recommendations. I found that, instead of the 5 A Day program, they are now using the MyPlate system, and recommending that Americans fill half of their plate with FFV and eat a variety of FFV every day.

 

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