Evaluating free school fruit: results from a natural experiment in Norway with representative data

Objective: To assess impacts of the nationwide Norwegian School Fruit Scheme (NSFS) using nationally representative data. Design: The NSFS is organized such that primary-school children (grades 1-7) are randomly assigned to one of three school fruit arrangements: (i) the child receives one free fruit or vegetable per day; (ii) the child is given the option to subscribe to one fruit or vegetable per day at a subsidized price; and (iii) the child attends a school that has no school fruit arrangement. Setting: Data from an Internet survey are used to compare child and parental fruit and vegetable intakes across the three NSFS groups focusing mainly on groups (i) and (iii). The analysis was conducted using multivariate regression techniques. Subjects: Parents of primary-school children (n 1423) who report on behalf of themselves and their children. Results: Children who receive free school fruit eat on average 0.36 more fruit portions daily -or 25.0% more fruits-than children who attend schools with no fruit arrangement (P<0.001). Moreover, parents of children who receive free school fruit eat on average 0.19 more fruit portions daily - or 12.5% more fruits - than parents of children who attend schools with no fruit arrangement (P=0.040). No significant associations were found between the NSFS and the vegetable intakes of children and their parents. Conclusions: The study shows, using nationally representative data, that free school fruit is associated with increased child fruit intake and that it may also affect parental fruit intake.