M. G. Wagner 1 , K. Hert 1 , L. Myers 1 , J. Levine 2 , T. Heck 1 , Y. Rhee 1

1. Effects of Nutrition Education on Knowledge, Attitudes, and Behaviors Related to Fruit and Vegetable Intake M. G. Wagner1, K. Hert1, L. Myers1, J. Levine2, T. Heck1, Y. Rhee1 1Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, 2Family Nutrition Sciences, Concordia College, Moorhead, MN

2. Abstract • Introduction: Knowledge, beliefs, and availability have been shown to be determinants of successful behavior change related to fruit and vegetable consumption. However, few studies to date have examined the effects of nutrition education and provision of fruits and vegetables on changes in fruit and vegetable-related knowledge, attitudes, and behaviors. • Purpose: The objectives of this study were to identify determinants of fruit and vegetable intake and evaluate the effectiveness of a 10-week community-based nutrition education program on improving knowledge, attitudes, and behaviors related to fruit and vegetable consumption among overweight and obese adults. • Methods: Fifty-four adults (19 men/35 women; age 44.7±12.1 y; body mass index 33.2±7.7 kg/m2) were randomly assigned to one of three intervention groups. The control group received no intervention, the education group attended weekly nutrition lessons, and the fruit and vegetable group attended weekly nutrition lessons and received one serving of fruits and two servings of vegetables per day for 10 weeks. Fruit and vegetable-related knowledge, attitudes, and behaviors were assessed at pre-test and post-test using 30-item questionnaires. • Results: The main determinants observed to impact fruit and vegetable-related behavior among participants included attitudes, knowledge, and exposure, more so than availability. Participants who received nutrition education, especially those who received fruits and vegetables, reported more improvements in knowledge, attitudes, and behaviors related to fruit and vegetable consumption compared to the control group. • Discussion: Knowing the effects of nutrition education and fruit and vegetable provision on determinants of consumption may be helpful to practitioners planning nutrition intervention programs for overweight and obese adults.

3. Introduction • The number of adults struggling with overweight or obesity continues to rise each decade.A key contributor to this rise is increased consumption of energy-dense foods.1 • Fruits and vegetables (FV), when consumed in place of energy-dense foods, have been shown to aid in weight loss and prevention or postponement of chronic diseases.2

4. Introduction • Despite numerous health benefits, consumption of FV is poor in comparison to recommendations stated in the Dietary Guidelines for Americans, 2010.3 • Previous research suggests that several factors, including knowledge, beliefs, cost, convenience, exposure, and taste, are determinants of successful behavior change related to FV consumption.4

5. Purpose • To determine the effectiveness of a community-based FV education program on improving knowledge, attitudes, and behaviors among overweight and obese adults • Goals were to identify perceived and actual barriers to FV consumption, and improve knowledge, attitudes, and behaviors related to FV intake

6. Methods • Study protocol was approved by the North Dakota State University Institutional Review Board • Participants • 54 adults • Inclusion • Age over 18 years • BMI > 25 kg/m2 • Exclusion • History of bariatric surgery • Current smoker • Pregnant

7. Study duration Pre-testing (2 weeks) Intervention (10 weeks) Post-testing (2 weeks) Data Collection Demographics Knowledge & Attitudes Questionnaire Food Frequency Questionnaire Methods

8. Methods

9. Methods Intervention Groups Control group (n = 8) No intervention Education group (n = 19) Received information about fruits, vegetables, and antioxidants Fruit/Vegetable group (n = 26) Received same information as education group + FV supplementation  one serving of fruits and two servings of vegetables per day

10. Methods • Curriculum • Developed at The University of Georgia • Each lesson was ~30 minutes in duration • Lessons included: • Benefits of FV consumption • Proper selection and storage of FV • Recommended serving sizes • Nutrients present in various FV • Food demonstrations, handouts • Examples of topics: • Citrus fruits, leafy greens, squash and pumpkin

11. Methods Statistical Analysis PASW version 18.0 (SPSS Inc., Chicago, IL) Alpha level < .05 Descriptive statistics Chi square test for independence Follow-up pairwise comparisons

12. Knowledge * * * *Significant relationship between knowledge variable and intervention group.

13. Attitudes * * * *Significant relationship between attitude variable and intervention group.

14. Behaviors * * * * * *Significant relationship between behavior variable and intervention group.

15. Discussion Improvements in knowledge and attitudes among those who received education are consistent with research identifying knowledge and self-efficacy as key factors in producing behavior change.4,5 Provision of FV was found to contribute additional improvements in fruit and vegetable-related attitudes and behaviors, suggesting the importance of being exposed to FV.6

16. Conclusions Nutrition interventions for overweight and obese adults need to thoroughly address attitudes, knowledge, and provide exposure to FV. Further research is needed to assess if improvements in knowledge and attitudes lead to sustainable improvements in FV consumption, subsequent weight loss, and decreased disease risk.

17. References • Centers for Disease Control and Prevention. Obesity and overweight. Available at: http://www.cdc.gov/nchs/fastats/overwt.htm. Accessed November 17, 2011. • Quadir T, Akhtar-Danesh N. Fruit and vegetable intake in Canadian ethnic populations. Can J Diet Pract Res. 2010;71(1):11-16. • U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 (7thed). Washington, DC: U.S. Government Printing Office; 2010. • Guillaumie L, Godin G, Vezina-Im L. Psychosocial determinants of fruit and vegetable intake in adult population: a systematic review. Int J BehavNutrPhysAct. 2010;7:12-23. • Reuter T, Ziegelmann JP, Wiedemann AU, Geiser C, Lippke S, Schuz B, et al. (2010). Changes in intentions, planning, and self-efficacy predict changes in behaviors. J Health Psychol2010;15(6):935-947. • Kidd T, Peters PK. Decisional balance for health and weight is associated with whole-fruit intake in low-income young adults. Nutrition Research. 2010;30:477-482.