Impact of Nutrition Education on Fruit and Vegetable Consumption in an Urban School District

Objective: The purpose of this study was to evaluate the impact of nutrition education on fruit and vegetable consumption when provided as an addition to the Fruit and Vegetable Program (FFVP). The secondary purpose was to compare fruit and vegetable consumption between students who received the FFVP and students who did not receive the FFVP. Methods: This was a quasi-experimental study which involved three schools; one received both the FFVP and a nutrition education program, one received the FFVP only, and one received neither the FFVP nor nutrition education. Students in the intervention group received eight nutrition lessons. Students in each participating school completed a pre and post survey separated by eight weeks. The survey assessed daily fruit and vegetable consumption. Results: A total of 230 students completed pre and post surveys, intervention group (n=87) and the two control groups FFVP (n=73) no-treatment (n= 70). There was a significant effect of group on change in fruit consumption (F=8.4, p<0.001) and vegetable consumption (F=4.6, p=0.01) in repeated measures analysis of variance with the intervention group differing from the two control groups (p<.05) for both fruit and vegetables. In addition, the intervention group increased fruit by 0.89±1.75 pieces/day (p<0.001) and vegetables by 0.81±1.8 times/day (p<0.001) in within group analyses (paired t-tests). There was no change from pre to post for either fruit or vegetable in either control school. There was no effect of FFVP on fruit or vegetable consumption


INTRODUCTION
Childhood obesity among children aged 6-11 has risen from 7% in 1980 to 18% in 2012. 1 According to the Dietary Guidelines Advisory Committee, childhood obesity increases the risk of developing chronic diseases later in life. 2 Fruit and vegetable (F/V) consumption is related to healthier eating habits and reduction in the incidence of childhood obesity. 3 The 2010 Dietary Guidelines for Americans (DGA) recommend 1 ½ cups of fruit and 2-2 ½ cups of vegetables for children [6][7][8][9][10][11]. 3 An evaluation of F/V consumption among children from 2003 to 2010 found a 12% increase in fruit with no change in vegetable consumption. 4 Despite the increase in fruit consumption, 60% of children were still not meeting the recommendations for fruit consumption, and 93% were not meeting recommendations for vegetables. 4 While Guidelines for F/V were not met by any socioeconomic class, there is evidence that low-income children have less fresh F/Vs regularly available in the home than higher income children. 5,6 Economic challenges and access limitations make it difficult to increase availability in the home. However, the school food environment provides opportunities for increased availability at breakfast and lunch as well as F/V snacks during the school day. [5][6][7] The United States Department of Agriculture offers child nutrition programs that provide healthful foods to low-income students. These programs define low-income students as those who qualify for free or reduced-priced meals. [5][6][7] Two of these, the School Breakfast Program (SBP) and the National School Lunch Program (NSLP), reimburse schools or school food providers for meals provided to students. 6,7 These programs have set reimbursement guidelines which require specific ranges for nutritional value for meals and amounts for weekly and daily food group components.
The NSLP also requires students have at least three food groups, one must be a fruit or vegetable, on their lunch tray . 8 An additional child nutrition program, the Fresh Fruit and Vegetable Program (FFVP), provides F/V snacks, but this program is not provided to all schools. 5 The FFVP is designed to provide low-income students the opportunity to regularly experience a variety of fresh F/V with a goal of increasing F/V consumption. The program provides fresh F/V to all students in participating schools at least twice a week at separate times from either SBP or NSLP meals. While the FFVP also encourages providing nutrition education as part of effort to meet goals, it does not provide funding for the education. 5 Nutrition education has been associated with increased F/V consumption. A review of studies that evaluated the impact of nutrition education on F/V consumption found varied results. Studies in which the educators received training prior to and/or used a uniform curriculum tended to result in increased consumption, 9,10 while studies, where educators were responsible for the design and implementation of their nutrition education lessons, tended to be ineffective. 11 Barriers related to providing nutrition education have been identified as lack of nutrition education training for the educators and lack of materials available, which may explain the varied study results. 12,13 Access and exposure to F/V have been associated with increased consumption among children. [14][15][16] Evaluation of the FFVP found students in schools participating in the FFVP consumed ⅓ cup more F/V on distribution days than students in non-participating schools. 15,16 Additionally, evaluations of school food environments have found positive associations between schools that participated in child nutrition programs and F/V availability. 17 The University of Rhode Island Supplemental Nutrition Assistance Program-Education (SNAP-Ed) developed a nutrition education curriculum to provide the education component that is recommended by the United States Department of Agriculture FFVP. 5 Lesson materials consisted of a lesson plan, activity worksheets/handouts which reinforced the lesson, and parent letters. The activity worksheets/handouts were designed for use in a lesson or as take-home reinforcement.
Some lessons included additional classroom activity materials such as story books provided to the library and posters that offered visual lesson materials or interactive group work. The effect of this curriculum was evaluated using a quasi-experimental design. Holmes found that while vegetable consumption increased in the education group compared to the control group, there was no difference in fruit consumption. 18 The Social Cognitive Theory (SCT) posits that individuals and the environment will interact reciprocally leading to personal and social change. 19 According to the SCT, implementation of nutrition education in classrooms where students are participating in the FFVP should lead to increased FV consumption.
Mechanisms include increased knowledge about fruits and vegetables and their health benefits (positive outcome expectancies) and modeling by classmates consuming the FFVP snack.
Separately nutrition education and the FFVP have had an effect on increased F/V consumption but to the author's knowledge, no study has compared the effect of a combined program to a non-treatment control. The purpose of this study was to determine if the combination of FFVP and education increased intake of F/V more than FFVP alone and a non-treatment control. The secondary purpose was to compare F/V consumption between students who received the FFVP to students who did not receive the FFVP.

Design:
This quasi-experimental study involved three schools; one received both the FFVP and a nutrition education program (FP), one received the FFVP only (FM), and one received neither the FFVP nor nutrition education (FN). Students in each participating school completed a pre and post survey separated by eight weeks. The survey assessed daily fruit and vegetable consumption. The primary hypothesis was that students in the combined FFVP plus nutrition education group would increase consumption of fruit and vegetables more than the students that received the FFVP without education as well as students that received neither the FFVP nor nutrition education. The secondary hypothesis was that students who received the FFVP (both schools combined), would have a higher intake of F/V at baseline and post than those students that did not receive the FFVP. This study was approved by the Institutional Review Board of the University of Rhode Island.
The nutrition education curriculum: The nutrition education curriculum taught in this study was developed by the University of Rhode Island SNAP-Ed nutrition program. This study utilized separate curricula for the third and fourth grade that provided developmentally appropriate lessons on fruits and vegetables. The materials provided in the curriculum included eight mini lesson plans, handouts, activities, worksheets, and parent newsletters. The original intent for lesson delivery coincided with the distribution of the FFVP cups.
However, that time frame does not always fit with a teacher's classroom flow.
Therefore, the design of the curricula allowed for flexibility of delivery time, both for the length of the lesson and time of the day. Lesson topics for each grade are provided in Table 1. The full curriculum is available in Appendix B and C. The parent letters are available in Appendix D and E.

Instrument:
This study used an existing two question SNAP-Ed survey to assess fruit and vegetable consumption. The amount of fruit consumed was assessed by one question asking;" How many pieces of fruits did you eat yesterday? Do NOT include fruit juice." Students responded by filling in a circle indicating "none," "1 pieces," "2 pieces," "3 pieces," "4 pieces," "5 or more." The frequency of vegetable consumption was assessed by one question asking, "How many times did you eat vegetables yesterday? Do NOT include French fries." Students responded by filling in the circle indicating "none," "1 time," "2 times," "3 times," "4 times," "5 or more." The rationale for assessment in different units (pieces/times) was based on cognitive interviews demonstrating the separate units were easier to comprehend for children.
Survey administration protocol started with the following prompt that was read aloud to students, "Think about what you ate yesterday; from the time you woke until when you went to bed." Then each question of the survey was separately read aloud.
Students were encouraged to ask clarifying questions. Where a significant effect between schools was found, posthoc Tukey tests were conducted for both F/V to compare schools. Paired t-tests were used to assess within school changes. To assess F/V consumption based on exposure to the FFVP, data were separated into two groups (students receiving the FFVP and students not receiving the FFVP). Independent t-tests were used to compare F/V consumption at baseline between the two groups. Analysis of covariance was performed to compare F/V consumption at post while controlling for baseline intake.
The FP data were collected on different days of the week while FM and FN data were collected on Thursdays in which the day prior was a school day and not a FFVP distribution day. One class at the FP completed surveys in which the day prior was not a school day.Repeated measures of analysis of covariance were performed to assess the effect of non-school day consumption on F/V consumption over time. One class at the FP completed surveys on a day in which the FFVP distribution occurred on the day prior. Repeated measures of analysis of covariance were performed to assess the effect of FFVP distribution on F/V consumption over time. All data were analyzed using SPSS (IBM, 22.0, Armonk, NY).

DISCUSSION
This study was based on a prior study comparing FFVP plus nutrition education to FFVP alone. To this author's knowledge, it was the first time these three groups (FFVP plus nutrition education, FFVP alone, and neither education nor FFVP) were studied together. Additionally, this study targeted low-income children in urban schools which provided increased availability of F/V through the SBP, NSLP, and the "garden cart" daily salad bar. The intent of this study was to assess the impact of a nutrition education curriculum designed to complement the FFVP program on F/V consumption. Results found that the combination of nutrition education and participation in the FFVP increased both fruit and vegetable consumption among third and fourth grade students. Although this study found an increased intake of fruit at post test in the FFVP schools, there was no effect of the FFVP on baseline F/V intake.
This study found a significant difference between groups for F/V consumption from baseline to post-intervention. There was an increased intake in the intervention group for fruit (0.89 pieces/day) and vegetables (0.81times/day) and no differences in either control group. However, it is not possible to compare intake to the 2010 DGA two-year study (n=106) which provided nutrition education curricula with some teacher training. This study found there was a significant effect on intake from pre to post-intervention between groups for both fruit (p=0.001) and vegetables (p<0.001) with increased intake for the intervention group (fruit 24.6 grams and vegetable 36.6 grams) and decreased intake for control. 9 Similarly, an additional multicomponent study conducted by Prelip et al. involved three groups in which two utilized an established curricula and the third group was responsible for providing their own curricula, found the third group had the least effect on F/V intake. 11 As discussed above, the eight-week study conducted by Holmes which utilized the study curriculum only found a significant increase in vegetable intake (0.25 cups, p=0.027) from pre to post-intervention. 18 In contrast, a one-year study conducted by Rosario et al. which involved extensive teacher training but did not provide curricula for the study, found no significant effect between groups at post-intervention for fruit (p=0.095) or vegetables (p=0.147). 10 This study's findings are consistent with other studies that provided nutrition education curricula. 9,11 A significant difference in F/V consumption at baseline and post-intervention between participants in the FFVP compared to non-participants was expected.
Contrary to other studies there was no effect at baseline, and the only effect was found in fruit intake at post-intervention (p=0.001 with the intervention group increasing intake and control group decreasing intake.
Possible explanations for the lack of effect of the FFVP at baseline include the sample size and the F/V availability at baseline. Previous studies, which found a difference in F/V intake between participants in the FFVP and non-participants, involved significantly larger sample sizes than in this study. In contrast to other studies, all schools in this study provided extensive F/V availability during school meals which may explain why there was no difference in F/V intake at baseline between participants in the FFVP and non-participants in this study.
Increased F/V consumption was an expected outcome of this study. This expection was based on the principles of the Social Cognitive Theory 19 related to modeling behaviors of classmates, increasing nutrition knowledge, and the bi-weekly repetition of FFVP cup distribution. This study did not include direct observation and did not assess the students' knowledge or attitudes related to F/V. Future studies which include these assessments may reinforce study findings.
Strengths of this study include the target population which was representative of those children at increased risk of childhood obesity 1,23 and the F/V availability in the target schools provided through the SBP, NSLP, and the "garden cart". Finally, this survey excluded fruit juice and french fries both of which were included in other studies 4,24 suggesting the nutrition education component had an impact on not only F/V intake but also on diet quality.
One limitation of this study was that survey administration for the intervention group occurred on different days of the week. Although this affected exposure to the FFVP as well as school F/V availability on the previous day, there was no effect of day on intake in the intervention school. However, future studies should control for the day of the week. school selection was a limitation as the schools included in the study were not selected at random. While school selection and the instrument were limitations, the schools all had F/V available to students and the assessment of intake found that the nutrition education component had an effect on F/V consumption.

IMPLICATIONS FOR RESEARCH AND PRACTICE
The findings from this study suggest low-income students would benefit from

Introduction
This literature review will explore the prevalence of childhood obesity with attention to risk factors related to income and race. The second portion of the review will explore interventions to promote fruit and vegetable (F/V) intake in schools.
Interventions include government programs, modifications to the school food environment, and nutrition education programs.

Obesity in Children
The Obesity prevalence was significantly lower among non-Hispanic Asians as compared to non-Hispanic whites (p=0.04), non-Hispanic blacks (p<0.001), and Hispanics (p<0.001). 1 Additionally, prevalence was significantly lower among non-Hispanic whites as compared to non-Hispanic blacks (p=0.048) and Hispanics (p<0.001). No significant difference was found between non-Hispanic blacks and Hispanics. The main finding was that while the prevalence of obesity among children aged 6-11 has been consistent from 2003-2012 there are significant differences in obesity prevalence between groups when categorized by race/Hispanic origins.

Fruit and Vegetable Consumption
Several studies have analyzed NHANES F/V intake data among children 6-11. 4-6 All data were obtained from 24 hour dietary recalls and defined total fruit consumption as whole fruit and 100% fruit juice and total vegetables including french fries. Lorson  The MyPyramid recommendations for children in the 6-11 age range was three servings of fruit and four servings of vegetables daily. One serving of fruit has been defined as one medium apple, banana, orange or pear, a ½ cup of cooked, chopped, or canned fruit, or ¾ cup of juice. One serving of vegetables has been defined as one cup of raw leafy greens, a ½ cup of any other type of vegetables raw or cooked, or ¾ cup of juice. 7 6 There was no difference F/V intake or percent meeting recommendations among children aged 2-18. However, a higher proportion of adults with household incomes <185% FPL failed to meet recommendations for total fruit, whole fruit, and vegetable intake was significantly higher than those with higher incomes. Similarly, a higher proportion of non-Hispanic blacks failed to meet recommendations for fruit and vegetables than non-Hispanic whites and Mexican Americans.
These studies 4,6 demonstrated inadequate F/V intake among children aged [6][7][8][9][10][11]. Although there were no differences among children, there was greater risk for inadequate intakes of F/V in low-income or minority adults than those with higher incomes and non-Hispanic whites.

Promoting Fruit and Vegetable Intake
Healthful diets that include adequate F/V consumption help prevent obesity in children. 3 Different types of programs have been developed to increase F/V consumption among school children such as providing nutrition education, facilitating access, increasing promotion, and changing the school food environment. The government has established several child nutrition programs designed to provide lowincome children with healthful foods. One of these programs, the Fresh Fruit and Vegetable Program (FFVP), will be reviewed in this section.

The Fresh Fruit and Vegetable Program
The FFVP is specifically designed to provide F/V snacks to low-income children during the school day. The rationale is that low-income children have less opportunities to consume fresh fruits and vegetables. 8 The goals of the FFVP include making a difference in children's diet to improve their present and future health.
Specific goals include increasing children's F/V consumption and exposing children to a wider variety of fruits and vegetables.
The FFVP is unique as eligibility is only offered to elementary schools that already participate in the National School Lunch Program (NSLP), a child nutrition program which provides healthful lunches. Eligibility is also based on a school's percentage of students eligible for free or reduced meals. The program provides F/V two or more times per week for all students in the school at a set rate of $50-$75 per student per school year. The set monetary rate includes administration and food preparation costs. Excluded costs include education and F/V promotional materials.
Despite educational costs being excluded from the FFVP, schools are encouraged to include nutrition education whenever possible as students may lack or have limited knowledge or exposure related to fresh fruits and vegetables.
Evaluation: Does participation increase consumption?
Olsho et al. 9 and Bere et al. 10 conducted studies to evaluate the effect of F/V programs on intake. Both the FFVP in the US and the Norwegian School Fruit Programme in Norway were established in response to low F/V intake. An additional study by Bere et al. 11 followed up with original participants to assess long-term effects of the F/V program both on consumption and associations with weight status.
An evaluation of the FFVP's effect on F/V intake was conducted by Olsho et al. 9 This study examined F/V intake during school, outside of school, and combined for one day. F/V intake was also reported as either fresh or not fresh. for BMI ≥25 (overweight) between the intervention (15%) and the control group (25%) p=0.04. Additionally, data suggested that the overall odds of a person, in the intervention group, becoming overweight was 52% lower than a person in control group. Variables such as gender, grade in school, and parents' education level did not affect these odds. This study suggests that provision of free fruit in schools can play role in the prevention of childhood obesity.
Studies reviewed in this section found F/V intake significantly increased among students exposed to school fruit/vegetable programs. One long-term study found that intake after exposure was still higher than baseline and participation in the fruit program was associated with reduced odds of obesity. 11 School food environment Given that students are in school for the majority of day, the school food environment can provide an opportunity to develop healthful eating habits through offering increased F/V and limiting competitive foods such as sugary and fatty snacks.  12 They found the proportion of schools that offered fresh fruit, salad, and vegetables (not potatoes) on most days was higher for schools that participated in the NSLP and FFVP than those in NSLP only. This study also found that schools participating in the FFVP were twice as likely to offer fresh fruit most days as schools which did not participate (OR 2.07, 95% CI 1.12 -3.53); participation did not affect the proportion that offered salad or vegetables. These findings suggest that participation child nutrition programs increases fruit and vegetable availability.

Nutrition Education
Having fruits and/or vegetables available does not guarantee they will be consumed. There are many factors involved in food choices and some of these factors can be influenced by nutrition education increasing knowledge, skills, and attitudes. 14 Rosario et al. 15 , Kristjansdottir et al. 16  intervention. There were no overall changes in total fruit, whole fruit, or total vegetable from baseline to post or between groups. However total fruit and total vegetable intake in the intervention group were found to be significantly higher than control when adjusted for gender, age, baseline total energy intake, parents' education, and baseline BMI. Among obese participants, the intervention group intake at follow-up was significantly higher for total fruit (115.3 g vs. -168.2 g, p=0.030), whole fruit (52.7 g vs. -161.4 g, p=0.02), and total vegetable (81.9 g vs. 11.6 g, p=0.046).
Kristjansdottir et al. conducted a two-year study to assess the effect of nutrition education on dietary intake. 16 All education materials were developed specifically for this study. In the beginning of the study the researchers were involved in the delivery of the education materials to the students but as the study progressed, additional materials were developed and the teachers delivered the education. Education materials included a teacher's binder containing seven sections with topics and a variety of assignments available. All intervention schools provided the same homework assignments and encouraged students to bring in F/V snacks from home.
Dietary intake was assessed through a three-day continuous food record completed by parents for all food not provided through the school. Intake at school was assessed by staff. All parents were given food scales and instructions on how to measure and record food prior to baseline assessment. This two-year study obtained baseline data from students at the beginning of the second grade. The nutrition education was implemented over two school years. Post intervention data were collected at the beginning of the fourth grade. A total of 265 students in 6 elementary schools were invited to participate in the study. Three schools received the intervention and three were in control group. Final analysis included matched pre/post data for 106 students; 58 from the intervention group and 48 from the control group. Vegetable intake at post was higher for intervention group than control (p<0.001). Intake changes from baseline to post were significantly higher in the intervention group for fruit (p=0.001) and vegetables (p<0.01) compared to the control group. This study found that F/V intake in the nutrition education group increased by 47% from baseline as compared to a decrease in F/V intake in the group not receiving the education. Most, but not all, studies found nutrition education, particularly when curriculum based, influences F/V intake. However, many teachers are not aware of many of the nutrition education resources available.

Preliminary Study
Holmes conducted a study to assess the effect of nutrition education on F/V consumption in a population already participating in the FFVP. 20 Third and fourth grade students from two school districts, one assigned to the intervention group This study involved a large population of students in two similar school districts that were already participating in the FFVP. It also developed a nutrition education curriculum to complement the FFVP, and provided training for the classroom teachers on the curriculum. While this study did not find significant changes in fruit intake, there was a significant change in vegetable consumption on the overall intervention group.

Conclusion
Childhood obesity continues to be of concern in the US. Inadequate F/V consumption has been identified as a risk factor of becoming obese. Most children are not meeting daily F/V recommendations with increased risk of inadequacy among children in low-income households and non-white races. The FFVP was been established in response to these concerns, and evaluations found it promoted F/V consumption and increased F/V availability in schools. Nutrition education also can increase F/V consumption. The literature has shown that F/V programs and nutrition education both promote F/V consumption separately. These brief lessons have been developed to be taught during the time at which the fruit and vegetables are distributed. We have included extra activities at the bottom of some lesson pages which are meant to be flexible so they may be incorporated into your existing classroom curricula. Also, a parent newsletter is included in this program which should be sent home after each week's activity. Thank you for supporting the program and for helping your students develop lifelong healthy eating habits.

How to use this curriculum
We would like you to choose one day each week when the children receive a fruit or vegetable snack to present the brief lesson provided. On the other day(s) that fruit and vegetables are distributed, we would ask for you to refer to the color message sheet attached. For example, if your fruit and vegetables are served on Tuesday and Thursday, please choose one of these days for the lesson and the other will be for the color sheet.
We have provided 5 different color sheets with an important nutrition message for the students to learn. For example, on the day that you use the color sheet, if the fruit or vegetable is red, please refer to the red sheet and read the saying provided, then have the students repeat the phrase. In addition, if fruit is served that day, please read the fruit message, and when a vegetable is offered, please read the vegetable message. Eventually, your students will be able to come up with each day's message on their own. favorite food from each food group on the plate on the other side. Add-on: Silly Story: Have students work with a partner to write a silly story. Partners can read the story to each other when their story is complete. o Review the vegetable serving sizes: _ 1 cup of vegetables=size of a baseball= 1 cup broccoli _ ½ cup of vegetables= size of small computer mouse= 6 baby carrots _ ½ cup of vegetables received as a snack in school= size of small computer mouse Ask_ How many servings this size will it take to = 2 cups of veggies which you should eat every day? _ Take a look at today's fruit or vegetable snack. Have students estimate the serving size of the snack. Compare it to the size of a tennis ball and a computer mouse. _ Notice how these fruits and vegetables are all different colors. We'll be talking about why that's important next week.

Activity #2: Make a Fruit and Vegetable Diary
Follow the directions on the paper. Have students record how many fruits and vegetables they eat each day for one week. Did the children eat 2 cups of fruit and 2 cups of vegetables each day?

Curriculum Connections (Reading/Language Arts): Fruit and Vegetable Reading Passages -Assign any or all of the four reading passages (Citrus Fruits, Pears, Root Vegetables and Salad
Greens) and ask the students to answer the questions in complete sentences.

Add-on: Power Search:
Have the students complete the Power Search word search.

Activity #2: A Variety of Fruits and Vegetables:
Instruct the students to complete the worksheet and share their responses with the class.

Lesson 5: Fruit-Go Slow Whoa
Nutrition Objective: 1. Students will be able to identify a "go" fruit, a "slow" fruit, and a "whoa" fruit. Supplies/Materials:  My Plate poster with colored bands and pictures of foods  3 fruit pictures (apple, applesauce, apple pie)  Fruit &Vegetables: Make Healthy Choices (one for each student; save for Lesson 6)  Chart paper or whiteboard  Red, green and yellow markers Opening:  Today we are learning about the fruit group and how to make the healthiest choices when we eat fruit. Ask What color is the fruit group? (red) Point to the red band on the poster. Ask Why is fruit important for your body? (Fruits contain vitamin C, which helps to protect you from getting a cold. Fruit also keeps our teeth, gums and bones strong and healthy. In addition, fruit contains fiber which keeps food moving through your body so it helps you go to the bathroom.) Ask How many cups of fruit do you need every day? (2 cups)

Activity#1: Go Slow Whoa
 Write the word "go" in green, " slow" in yellow and "whoa" in red in a column on the board or chart paper. Display the 3 pictures of fruit.  In the fruit group, there are healthy fruits we should eat every day. These are called "go" fruits.
Ask Who can name a "go" fruit we should eat every day? (orange, kiwi, apple, banana) Ask Why are these healthy fruits? (They are in their natural form; the way you would get them right from a plant or a tree. Nothing has been added to the fruit like sugar or fat such as butter.) Ask Which of these three fruits would be the "go" fruit or the healthiest fruit? (the apple)  Display the picture of the apple on the board or chart paper next to "go".
 There are other fruits we call "slow" because we should only eat them sometimes. Ask Which of these two is the "slow" fruit? (applesauce) Why? (It has sugar added to it.)  Display the picture of applesauce on the board or chart paper next to "slow".
 The apple pie is a "whoa" fruit which you should eat only once in a while. AskWhy? (Apple pie has lots of fat and sugar added to it. It is not as healthy for us, even though it is made out of apples. We should only eat "whoa" foods once in a while.)  Display the picture of the apple pie on the board or chart paper next to "whoa". Ask How can you remember "go", "slow", and "whoa"? (It's like the colors of a stoplight).
 Distribute Fruit and Vegetables: Make Healthy Choices handout. Ask the children to save it for Lesson 6.  Continue to ask questions re: go, slow and whoa fruits by looking at the pictures.
Classroom Connections: (Language Arts): Fruit Fun Talk -Have the students work with a partner to complete Fruit Fun Talk. Review the answers with the class.

Lesson 6: Vegetables-Go Slow Whoa
Nutrition Objective: 1. Students will be able to name a "go" vegetable, a "slow" vegetable, and a "whoa" vegetable.

Supplies/Materials:
_ My Plate poster with colored bands and pictures of foods _ 3 vegetable pictures (baked potato, mashed potato and French fries) _ Fruits & Vegetables: Make Healthy Choices handout (saved from Lesson 5) _ Chart paper or whiteboard _ Red, yellow and green markers Opening: _ Today we are learning about the vegetable group and how to make the healthiest choices when we eat vegetables. Ask_ What color is the vegetable group? (green) Point to the green band on the poster.

Ask_ Why are vegetables important for your body? (Vegetables contain lots of important vitamins and minerals that keep us healthy and strong, and fiber which keeps food moving through your body so it helps you go to the bathroom.)
Ask_ How many cups of vegetables do you need to eat every day? (2 cups) Activity#1: Go Slow Whoa _ Write the word "go" in green, "slow" in yellow and "whoa" in red in a column on the board or chart paper. Display the 3 pictures of vegetables. _ In the vegetable group, there are healthy veggies we should eat every day. These are called "go" vegetables. Ask_ What are some examples of "go" vegetables that we should we eat every day? (green beans, broccoli, carrots, corn, celery, cucumbers, zucchini, tomatoes, peppers) Ask_ Why are these healthy veggies? (They are in their natural form; the way you would get them right from a plant. Nothing has been added to the vegetables like salt and fat such as butter or oil.) Ask_ Which of these three vegetables would be the "go" or the healthiest vegetable? (baked potato).
_ Display the picture of the baked potato on the board or chart paper next to "go".
_ We call some vegetables "slow" because we should only eat them sometimes. Ask_ Which of these two is the "slow" vegetable? (mashed potato) Why? (When you prepare mashed potatoes, you add some butter, milk and salt to the potatoes.) _ Display the picture of mashed potatoes on the board or chart paper next to "slow".
_ The French fries are a "whoa" vegetable which you should eat only once in a while. Ask_ Why? (French fries are fried in lots of oil and salt is added. The French fries are not as healthy for us, even though they are made out of potatoes. We should only eat "whoa" foods once in a while.)  Display the picture of the French fries on the board or chart paper next to "whoa".
Ask How can you remember "go", "slow", and "whoa"? (It's like the colors of a stoplight.)  Ask the students take out the Fruit and Vegetables: Make Healthy Choices handout and discuss. Ask_ Can you think of another "go" "slow" "whoa" vegetable? (onions: raw="go", sautéed in oil="slow" and onion rings which are fried in lots of oil and have a lot of salt added="whoa" Classroom Connections: (Language Arts): Vegetable Riddles -Have the students solve the Vegetable Riddles. Review the answers with the class.

Lesson 7: The Plant Parts We Eat
Nutrition Objective: 1. Students will be able to identify three different parts of a vegetable plant we eat.

Supplies/ Materials: _ Tops and Bottoms by Janet Stevens _ The Plants We Eat Teacher's Guide
Opening: _ Today I will be reading a book about fruits and vegetables. As I read, be on the lookout for how vegetables are grouped by the different parts of the plant that we eat. Ask_ We eat the fruit of the plant when we eat these fruits and vegetables. Think of fruits and vegetables that grow on vines or on trees. What are they? (bananas, strawberries, blueberries, pears, grapes, tomatoes, cucumbers)

Classroom Connections (English/Language Arts): Santa Cruz Farms-
Read the letter about Santa Cruz Farms together and instruct the students to answer the questions in complete sentences.
Add-on: Using The Plants We Eat List as a teacher's guide, bring in different fruits and vegetables. Have the students identify which plant parts they represent.
Ask_ What happens when we ship apples thousands of miles around the world? (uses up lots of gasoline, creates pollution, apples get mushy and don't taste as good) _ Let's talk about the final step: disposing which means throwing your trash away. Ask_ Why is it better for the environment if you eat fresh fruits and vegetables rather than processed or packaged foods? (All the trash you create will break down and become part of the soil. You won't have to throw away a lot of packaging like paper or plastic.) Nutrition Objectives: 1. Students will be able to identify fruits and vegetables in their diets.

Classroom Connections (Social
2. Students will name one new fruit or vegetable that they would like to try in school.

Supplies/Materials:
x Stopwatch or clock with a second hand x Paper and pencil for each student Opening: x Over the next few weeks we will be learning about fruits and vegetables and why they are an important part of a healthy diet.
AskAE Why is it important to eat fruits and vegetables? (Fruits and vegetables are loaded with vitamins and minerals that help protect your body against germs and keeps your heart, brain, eyes, and skin healthy. Fruits and vegetables also contain fiber, which keeps food moving through your body so it helps you go to the bathroom.) AskAE How many servings of fruits and vegetables does your body need every day? (You need 2 cups of fruit and 2 cups of vegetables every day.)

Activity#1: Make a List
x Instruct students to write down as many fruits and vegetables as they can in one minute.
x Use a stopwatch or a clock to let the students know when to stop writing.
AskAE Now look at your list. Are there any fruits or vegetables on your list that you've never tried?

Activity #2: Analyze Your List
x Put a circle around the fruits and vegetables you've never tried.
x Put a rectangle around the fruits and/or vegetables that you don't like.
x Put a star next to the fruits and vegetables you're willing to try for the first time or try again.

Add -on:
Ask the students to share the names of fruits and vegetables they've written on their lists. Make a class list on the board. Stress the importance of having a good attitude and being willing to try new foods. Students should save their individual lists to refer to in future lessons.

Classroom Connections (Math):
From the class list on the board, ask students to raise their hand to vote for their favorite fruit. Place a tally mark indicating the number of students who chose that particular fruit. Discuss these terms: maximum, minimum, range, mode and median and list the answers on the board. Create a bar graph to organize the data. Repeat the lesson using the data for vegetables.

Lesson 2: MyPlate -Fruits and Vegetables
Nutrition Objectives: 1. Students will be able to identify the food groups on MyPlate. 2. Students will be able to state that half of their plate should be filled with fruits and vegetables.

Supplies/Materials:
x MyPlate poster with colored bands and pictures of food x Catch a Rainbow Every Day handout (one for each student; they need to save this for Lesson 3) Opening: x Today we are learning about the five food groups and MyPlate. Instead of MyPyramid, we now use MyPlate as a guide to help us eat more healthfully.

Activity #1: MyPlate poster
x Refer to the MyPlate poster, drawing attention to the foods pictured in each food group at the bottom of the poster. Ask the following questions to generate a discussion: AskAE What do you notice about the plate on this poster? (There are five different colors each representing a different food group.) AskAE Can you name a food group and some foods that belong in that group?
x Green is the vegetable group which includes carrots, lettuce, tomatoes, and cucumbers.
x Red is the fruit group which contains apples, bananas, grapes, and 100% juice.
x Orange is the grains group which includes cereal, bread, bagels, pasta and rice.
x Purple is the protein group which contains meat, fish, chicken, beans, eggs and peanut butter.
x Blue is the dairy group which includes milk, cheese, and yogurt.
x Let's take a closer look at the fruit (red) and vegetable (green) groups.
AskAE How much of the plate is full if you combine the fruit and vegetable groups? (one half) AskAEWhat meal do you eat that looks most like this plate? (dinner) x This means that half your plate should be filled with foods that come from plants or trees.
x Raise your hand if your dinner plate at home is half full of fruits and vegetables.
x Raise your hand if you are going to ask the person who cooks in your house to buy and/or prepare more fruits and vegetables. x Raise your hand if you've tried one new fruit or vegetable this week.

Activity:#2: Catch a Rainbow Every Day
x Pass out Catch a Rainbow Every Day handout. (Save it.) Introduce the concept of variety. AskAEWhy is it important to eat many different fruits and vegetables every day? (Your body needs lots of different nutrients which it will get if you eat a variety of fruits and vegetables.) AskAEWhat is an easy way to remember to eat a variety of foods and vegetables every day? (Eat a lot of different colored fruits and vegetables every day.)

Lesson 3: The Color Chart
Nutrition Objectives: 1. Students will be able to identify the body functions of three different colored fruits and vegetables.

Supplies/Materials:
x Catch a Rainbow (one for each student saved from Lesson 2) x The Color Chart (one for each student; they need to save it for future lessons) x Individual Color Sheets (needed for teacher only; located in front of binder) x Half My Plate Pledge Form (one for the entire class) Opening: x You've already learned that a healthy diet consists of foods that have a variety of colors. Today you will learn how each color affects the human body.

Activity#1: The Color Chart
x Pass out The Color Chart and ask the following questions to generate a discussion. Note: Examples of white fruits and vegetables are those that are white on the inside like a banana, pear, or a potato, or those that are white inside and out like mushrooms. x Chart paper on an easel or mounted on the board (for word wall) x Name That Fruit worksheet (one for each student) Opening: x Today we are learning about the amount of fruit you need to eat every day to be healthy.
AskAE Why is it important to eat 2 cups of fruit every day? (Fruit contains vitamin C, which helps keep you from getting a cold. Fruit also keeps our teeth, gums, and bones strong and healthy.) Show pictures of the following and hold up the appropriate measuring cup as you discuss: x 1 cup of fruit equals one piece of fruit like an apple, orange, or banana x 1 cup of fruit equals 1 cup of chopped fruit like fruit salad or fruit cocktail (packed in natural juice) x 1 cup of fruit equals 32 red seedless grapes x 1 cup of fruit equals ½ cup of dried fruit like raisins x 1 cup of fruit equals 8 fluid ounces of 100% fruit juice x 1 cup of fruit equals 2 small pieces of fruit like kiwi x ½ cup fruit received as a snack in school (You need 4 servings this size to equal the 2 cups of fruit you should eat every day.)

Activity#1: Word Wall
x Write the names of the fruits from children's responses on chart paper to start a word wall. Save it for Lesson 5 when you will be adding vegetables to it or creating a separate list for vegetables. Display the list in the classroom so the children can refer to it when they complete their food diaries in Lesson 5. x Chart paper on an easel or mounted on the board (for word wall) x Make a Fruit and Vegetable Diary worksheets (one for each student) Opening: x Today we are learning about the amount of vegetables you need to eat every day to be healthy. AskAE How many cups of vegetables do you need every day? (2 cups) AskAE Why is it important to eat 2 cups of vegetables every day? (Veggies contain vitamins and minerals that keep us healthy and strong. They also contain fiber, which keeps food moving through your body so it helps you go to the bathroom.) Show pictures of the following and hold up the appropriate measuring cup as you discuss: x 1 cup of vegetables equals 1 cup of raw or cooked vegetables like broccoli, corn, peas, cucumbers, green beans, mushrooms, tomatoes, peppers or zucchini Follow the directions on the Make a Fruit and Vegetable Diary worksheet. Instruct students to use the word wall as they record the fruits and vegetables they eat over the next 5 days. Remind them that all forms count: fresh, frozen, canned, dried, and 100% juice.

Classroom Connections (English/Language Arts):
Instruct the students to answer the questions on the right side of the Have Fun with Fruits and Vegetables worksheet and then solve the puzzle.

Lesson 7: The Right Stuff
Nutrition Objectives: 1. Students will be able to explain one health benefit of eating a diet rich in fiber, vitamin A and vitamin C. 2. Students will be able to name one food that is high in fiber, vitamin A and vitamin C.

Supplies/Materials:
x Vegetable Riddles (one for each student) x What Does Your Food Do For You? (reference sheet for teacher) x The Color Chart (students saved this in Lesson 3) Opening: x Today we are learning about fiber, vitamin A and vitamin C. Fruits and vegetables contain a lot of fiber and vitamins A and C, so it's important to your health to eat a variety of them every day. 1. Students will be able to name a fruit or vegetable they should eat every day, sometimes, or once in a while.

Supplies/Materials:
x MyPlate poster x 3 vegetable pictures (baked potato, mashed potatoes, French fries) and 1 fresh fruit cup x Fruit and Vegetables: Make Healthy Choices handout (one for each student) Opening: Today we are learning how to make the healthiest choices when we eat fruits and vegetables. Refer to Fruits and Vegetables: Make Healthy Choices handout.
x Fruits and vegetables are most healthy in their natural forms; the way you would get it right from a plant or a tree. We call these the "go" foods, meaning these are the healthiest fruits and vegetables because they contain a lot of nutrients. You should eat them every day. AskAE Who can come up and pick the potato which would be the "go" food (baked potato), the "slow" food (mashed potatoes because you add some butter and salt to it), and the "whoa" food? (French fries because they are fried in lots of oil and salt is usually added) x Call on someone to place the best example of a potato (baked) on the MyPlate poster.
AskAE What would be an example "go" fruit? (any fresh fruit or fruit packed in natural juice) x Call on someone to put fresh fruit on the plate. Notice that ½ the plate is full of fruit & veggies. Here are a few ideas for how to get your child to eat more fruit: -Add sliced banana or berries to cold or hot cereal.
-Pack a bunch of grapes or an orange instead of chips.
-Follow the meal with a fresh fruit salad.
-Try out the recipe below for Apple Smiles! Sincerely, The URI SNAP-Education Program 3rd Grade Lesson 2 Estimado Padre, En la escuela esta semana, su hijo/a está aprendiendo sobre la fruta.
-Poner un racimo de uvas o una naranja en vez de los chips en la lonchera.

rd Grade Lesson 3
Dear Parent, This week, your child is learning about vegetables in school.
Vegetables are an important part of a healthy diet. Fresh, frozen, or canned-they all provide us with plenty of essential nutrients. Your child should eat 2 cups of vegetables every day.
Here are a few ideas for how to get your child to eat more vegetables: -Add diced green pepper or tomato to a cheese omelet.
-Have your child ask for extra veggies on pizza.
-Try out the recipe below for Easy Cheesy Chicken and Broccoli.
-Serve baby carrots with low fat dip. Sincerely, The URI SNAP-Education Program

Easy Cheesy Chicken and Broccoli
Ingredients: Aquí hay unas ideas a ayudar a su hijo/a a comer más verduras: -Echar trocitos de pimiento verde o tomate en una tortilla de huevo.
-Servir zanahorias pequeñas con una salsa baja en grasa. In the United States, children see thousands of food advertisements every year, with most of the marketing dollars promoting unhealthy foods like fast food, candy, and sugary snacks and drinks. These ads are found on TV, the internet, and grocery store displays.
Encourage your family to think critically about the information they see in advertisements.
Remember that the advertiser's main goal is to get you to buy their product, not to keep you healthy! Sincerely, The URI SNAP-Education Program 3rd Grade Lesson 5 Estimado Padre, En los Estados Unidos, los jóvenes ven miles de anuncios para la comida cada año. Casi todo el dinero para el mercadeo se usa para promocionar los productos poco saludables, como la comida rápida, los caramelos y las meriendas y bebidas azucaradas. Se encuentra estos anuncios en la televisión, el internet y los escaparates de tienda.
Anime a su familia a estar analítica en cuanto a la información en los anuncios. No se olvide de que el objetivo principal de las empresas del mercadeo es convencer a la gente a comprar sus productos, ¡no ayudarle a ser sano! Here are some tips to remember when it comes to getting your family to eat more of these healthy foods: -your child's taste preferences will grow and change as quickly as they do! It may take 6-7 times before they like a new food.
-set up a "salad bar" at home or send your child on a fruit and vegetable scavenger hunt at the grocery store.
-show your child that you enjoy vegetables by taking an extra helping at dinner or saying how delicious they are! Sincerely, The URI SNAP-Education Program 3rd Grade Lesson 8 Estimado Padre, Esta semana, su hijo/a ha participado en unas actividades divertidas mientras aprende sobre la fruta y las verduras. Aquí hay unos consejos para usted en cuanto a ayudar a su familia a comer más de estos alimentos saludables: -las preferencias de su hijo/a siguen madurando y cambiando tan rápidos como él/ella. Tal vez toma 6-7 pruebas antes de que al niño le guste un alimento nuevo.
-monte un "salad bar" en casa o tenga una búsqueda para frutas y verduras con su hijo/a en el supermercado.
-demuestre su entusiasmo para las verduras comiendo dos Fruit and vegetables are an important part of a healthy diet. They are loaded with vita-mins and minerals that keep our heart, brain, eyes, skin, and immune system healthy. They also contain fiber, which is good for digestion. Unfortunately, only 23% of youth in Rhode Island eat the recommended daily amounts of fruit and vegetables.
Did you know that children need to eat 2 cups of fruit and 2 cups of vegetables every day? Give your family a veggie boost by trying out the Creamy Cucumber Dip recipe below.

Sincerely,
The URI SNAP-Education Program 4th Grade Lesson 2 Dear Parent, This week, your child has been learning about the different parts of the plant that we eat. For example, when we eat asparagus we are eating the stem of the plant, and when we eat carrots we are eating the root of the plant. We also eat the leaves, fruit, seeds, and flowers of fruit and vegetable plants.
Do you have a garden at home or live near a community garden? Take a trip with your family to see how many edible plant parts your child can name. You could also have a family pizza night using the Pizza Bites recipe below, and ask how many different plant parts your child can name in the meal (answers below).
Aquí hay unas ideas a ayudar a su hijo/a a comer más verduras: i Desayuno-Echar trocitos de pimiento verde o tomate en una tortilla de huevo.